Volume 102 ·  Issue 46 ·  2022

The incidence of colorectal cancer in China is increasing year by year, and the mortality rate remains high. To reduce cancer-related social and economic burdens, awareness of and research on colorectal cancer is of great significance. It is necessary to explore the research on colorectal cancer diagnosis, endoscopic treatment, and prevention. Focuses should also be placed on actively screening for colorectal cancer and improving the advanced adenomas detection rate, thereby building a colorectal cancer prevention and treatment system which meets the national conditions of China.

Early detection of colorectal cancer and precursor lesions under colonoscopy, and timely and optimal treatment remain the crucial means for reducing colorectal cancer-related deaths. In this article, we focused on the hot spots in recent years, reviewed the progress of endoscopic diagnosis and treatment of serrated lesions and inflammatory bowel disease (IBD)-related dysplasia, the application of endocytoscopy and the management of early colorectal cancer/precancerous lesions, and provided new prospects for future studies.

As the main composition of the gut microbiota, intestinal microbiota directly or indirectly regulate epigenetic modifications, a variety of metabolisms, mucosal and even systemic immune functions of the host, and exert a great influence on the biological behavior of colorectal cancer. Although the detailed mechanism of some enterobacteria involved in the progression of colorectal cancer remains unclear, they are possible markers for early warning and prognostic prediction of colorectal cancer, as well as potential targets for treatment and prevention, which provides us with new hope for the prevention and treatment of colorectal cancer.

The most common complications after pancreaticoduodenectomy include pancreatic fistula, biliary fistula, delayed gastric emptying, bleeding, and abdominal infection. Although advances in surgery have led to a significant decrease in perioperative mortality in recent years, the risk of complications after pancreaticoduodenectomy remains. Thus, prevention and treatment of various complications are important to improve the prognosis of patients.

Nerve fibers are important component in tumor microenvironment (TME) and have been shown to promote the early development of the prostate cancer and metastasis of advanced prostate cancer. Besides, it also activates an angio-metabolic switch, altering the endothelial cell metabolism to trigger angiogenesis. Most studies have showed that nerve infiltration in prostate cancer may be regulated by a variety of nerve growth factors secreted by cancer cells.However, surprisingly, neurons in the TME could also be neural progenitors originating from the subventricular zone. Recently, the effects of tumor-associated neuro-immune signal dysfunction on cancer promotion has gradually become a new focus. Therefore, elucidating the molecular and cellular mechanisms of nerve and its signaling in prostate cancer will help improve the value of clinical application of nerve targeted therapy.

To evaluate the screening performance of hypersensitive quantitative fecal immunochemical test (hs-qFIT) and qualitative fecal occult blood test (FOBT) for colorectal cancer and advanced adenoma.

Consecutive participants scheduled to undergo colonoscopy from April 2020 to April 2021 in Qilu Hospital of Shandong University were included in the study. All the participants were 50-75 years old and at moderate to high risk for colorectal cancer. Participants completed hs-qFIT and two kinds of qualitative FOBTs (colloidal gold method and chemical-immunization method) before colonoscopy. The sensitivities and specificities of hs-qFIT and two qualitative FOBTs for colorectal cancer and advanced adenoma were compared.

A total of 910 participants were enrolled in the study, including 451 males and 459 females, aged (59.6±6.4) years. There were 22 cases (2.4%) of colorectal cancer, 61 cases (6.7%) of advanced adenoma, 276 cases (30.3%) of non-advanced adenoma, 194 cases (21.3%) of non-adenomatous polyp, 85 cases (9.3%) of other colorectal lesion and 272 cases (29.9%) of non-colorectal lesion. The sensitivities of hs-qFIT for detecting colorectal cancer increased from 72.7% (95%CI: 49.6%-88.4%) to 100% (95%CI: 81.5%-100%) with cut-off value decreasing from 200 ng/ml to 10 ng/ml, and the sensitivities of both colloidal gold method and chemical-immunization method were 63.6% (95%CI: 40.8%-82.0%) (P=0.008). The detection stability of hs-qFIT for colorectal cancer was higher than colloidal gold method (P=0.016) and chemical-immunization method (P=0.031). The sensitivity for detecting advanced adenoma of hs-qFIT at 10 ng/ml was 52.5% (95%CI: 39.4%-65.2%), which was significantly higher than that of colloidal gold method (13.1%, 95%CI: 6.2%-24.8%, P<0.001) and chemical-immunization method (6.6%, 95%CI: 2.1%-16.7%, P<0.001).

The sensitivity and detection stability of hs-qFIT for detecting colorectal cancer was higher than qualitative FOBT. Moreover, the sensitivity for detecting advanced adenoma can be further improved using a lower cut-off value.

To study the clinical and endoscopic features of mantle cell lymphoma (MCL).

The clinical data and endoscopic characteristics of 20 patients with gastrointestinal MCL treated in the Affiliated Hospital of Zunyi Medical University and the Digestive Endoscopy Center of Guizhou Medical University from January 2011 to January 2021 were collected, and the histological and immunohistochemical characteristics of the tumor were observed. Meanwhile, 44 cases of non-gastrointestinal MCL in the above two hospitals in the same period were also enrolled. The clinical and endoscopic differences between the two groups were compared.

Among the 20 patients with gastrointestinal MCL, the male to female ratio was 4∶1 (16/4), the average age was (60.3±9.7) years, and 11 patients (55.0%, 11/20) were over 60 years old. The main clinical manifestations of 20 patients at the onset of the disease were bloody stool or black stool in 9 cases (45.0%), abdominal pain in 8 cases (40.0%). Moreover, 5.0% (1/20) had B symptoms (fever, night sweat and weight loss). The most frequently involved site was colorectum (50.0%). Endoscopic findings showed mucosal polypoid lesions in 13 cases (65.0%, 13/20), involving multiple intestinal segments, with polyp diameter of 0.2-3.5 cm. Two cases (10%) were in stage Ⅲ and 18 cases (90%) were in stage Ⅳ according to Ann Arbor staging. Seven cases (35.0%, 7/20) had the involvement of the peritoneal and retroperitoneal lymph nodes, 9 cases (45.0%, 9/20) had the involvement of the superficial lymph nodes in 45.0% (9/20), and 4 cases (20%, 4/20) had other extranodal invasion. Splenomegaly accounted for 35.0% (7/20). CD20, Bcl-2 and CD5 were positive or strongly positive in all gastrointestinal MCL tumor cells in 20 cases. Cyclin D1 was positive or strongly positive, accounting for 90.0% (18/20). The sex-determining region of Y chromosome-related high-mobility-group box 11 (SOX11) was positive or strongly positive, accounting for 65.0% (13/20). The positive index of Ki-67 was 5%-80%. Twenty cases (100%, 20/20) were followed up. The median follow-up was 41.2 months (1-74 months). There was no significant difference in the 3-year overall survival rate between the gastrointestinal MCL patients (70.0%) and non-gastrointestinal MCL patients (72.7%) (χ²=0.051, P=0.822).

Abdominal discomfort is the main symptom of gastrointestinal MCL, which often occurs in the colorectum and often presents with multiple polypoid lesions. There are relatively few cases with B symptoms and extranodal invasion, and the prognosis is not different from that of patients with non-gastrointestinal MCL.

To evaluate the endoscopic treatment efficacy of colorectal laterally spreading tumor (LST) and analyze the risk factors for delayed post-polypectomy bleeding (DPPB).

Between January 2015 and December 2020, patients underwent colorectal endoscopic submucosal dissection (ESD) or hybrid ESD were recruited from the Second Affiliated Hospital of Zhejiang University. Complete resection rate, perforation rate, bleeding rate, operation time and lesion adhesion were compared between the ESD and hybrid ESD groups. Patients were divided into bleeding and non-bleeding groups based on the presence of DPPB. Multivariate logistic regression analysis was used to analyze the risk factors of DPPB.

A total of 665 patients with colorectal LST were enrolled, including 376 males and 289 females, with an average age of (57.4±0.4) years. There were 471 cases underwent ESD and 194 cases underwent hybridized ESD. There were no significant differences in gender, age, history of smoking and drinking, and prevalence of hypertension between the two groups (all P>0.05). Likewise, the rate of lesion adhesion (4.2% vs 7.7%, P=0.067), lesion complete resection (96.8% vs 93.8%, P=0.418), perforation (0.6% vs 1.0%, P=0.594), delayed bleeding (2.8% vs 2.1%, P=0.605) were not statistically significant between the two groups. Seventeen patients (2.6%) developed DPPB after endoscopic treatment. Multivariate logistic regression analysis showed that the lesion was in the rectum (OR=3.594, 95%CI: 1.237-10.443, P=0.019) and the diameter of the lesion>2 cm (OR=3.776, 95%CI: 1.411-10.106, P=0.008) were risk factors for DPPB.

Both ESD and hybrid ESD are successful treatments for colorectal LST. Colorectal LST lesion site and lesion size>2 cm are risk factors of DPPB.

This study retrospectively analyzed the clinical medical records of patients with dual phenotypic liver cancer (DPHCC) and those (non-DPHCC) in the same period to seek quick and effective biomarkers for differential diagnosis.

A retrospective study was conducted on 164 patients who underwent radical hepatocellular carcinoma resection at Affiliated Hospital of Nantong University from May 2017 to May 2020, including 29 patients with DPHCC, accounting for 17.7% (age: 53.9±10.0). There were 135 non-DPHCC patients, accounting for 82.3% (age, 62.6±9.1). The clinical records of the above patients were collected,including the basic information of the patients, clinical symptoms and signs, history of infection, laboratory test indexes one day before surgery, postoperative pathological report and other relevant data, The follow-up time was 18 months and the data were complete. By analyzing the clinical data of DPHCC patients and non-DPHCC patients in the same period, to find quick and effective differential diagnostic indicators, and to explore the indicators indicating poor prognosis of DPHCC patients.

One-way ANOVA showed significant differences in age, AFP[143(4.8-984.8) vs 9.9(2.8-71.3) μg/L], NLR (3.650±1.924 vs 2.220±1.486), neutrophil count, lymphocyte count, vascular infiltration rate, TNM stage, Chinese Hepatocellular carcinoma Staging (CNLC), Child grade, and Japanese General Staging Score (JIS) (P<0.05). Multivariate logistic regression analysis identified age(OR score:0.967,95%CI:0.860-0.957) and NLR(OR score:1.564,95%CI:1.205-2.029) as independent risk factors for DPHCC differential diagnosis. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficiency of NLR, and the best cut-off value was 2.586. The combination of age at onset improved the efficiency of differential diagnosis. When reaching the maximum diagnostic efficiency, the area under curve(AUC) was 0.836, the sensitivity was 89.66%, and the specificity was 65.93%.

NLR combined with the age of disease has certain feasibility in predicting DPHCC and may be an effective index to distinguish DPHCC from non-DPHCC patients.

To evaluate the measurements of urethral pressure profile (UPP) using air-charged catheters (ACC) in women with bladder neck obstruction and to preliminarily analyze the diagnostic value of UPP based on ACC for female bladder neck obstruction.

Retrospective inclusion of 63 female patients with bladder neck obstruction diagnosed in the Department of Urology of Beijing Chao-yang Hospital from September 2020 to December 2021 were included as the observation group, and 45 female patients who came to the hospital due to lower urinary tract symptoms with non-bladder neck obstruction during the same period were selected as the control group. All patients received urodynamic examination and UPP examination based on ACC, and urethral pressure measurements [M (Q₁, Q₃)] were compared between the two groups and analyzed the predictive value of the relevant measurements for female bladder neck obstruction.

The age of the observation group was 61 (47, 67) years and body mass index (BMI) was 24.1 (21.6, 27.9) kg/m², the age of the control group was 65 (58, 71) years and BMI was 25.0 (22.8, 27.6) kg/m². The urethral pressure at the bladder neck and urinary sphincter position in the observation group were higher than control group[104.00 (83.00, 124.00) cmH₂O (1 cmH₂O=0.098 kPa) vs 42.00 (31.00, 65.50) cmH₂O, 125.0 (107.0, 154.0) cmH₂O vs 99.0 (77.0, 124.0) cmH₂O, P<0.001]. The results of the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of urethral pressure at the bladder neck position had the highest predictive value for female bladder neck obstruction (AUC: 0.946, 95%CI: 0.886-0.981, sensitivity: 87.3%, specificity: 91.1%), and the results of interaction point plot showed that the cut-off value was 72 cmH₂O. The cut-off value of urethral pressure at the bladder neck position was used as positive cut-off value to predict female patients with bladder neck obstruction. Sixty-three patients with bladder neck obstruction were detected by UPP measurement using ACC in 59 cases (59/63, 93.7%) and the Kappa value was 0.774 (95%CI: 0.654-0.894), indicating that UPP had high consistency with pressure-flow study.

UPP examination based on ACC can show the pressure values of the bladder neck and urethral sphincter position. When the urethral pressure of the bladder neck position is greater than 72 cmH₂O, it is helpful for the diagnosis of female bladder neck obstruction and has guiding significance for the diagnosis and treatment of this disease.

To explore the effect of "one-stop" outpatient management on the therapeutic schedule and control rate of patients with metabolic disorders.

A total of 332 patients who met the inclusion criteria were enrolled and treated regularly in the "one-stop" outpatient department of the Department of Cardiology of the Third Hospital of Peking University from November 1, 2020 to April 30, 2022. The general information, personal history, family history, drug treatment plan, blood pressure, height, weight, waist circumference, and hip circumference of patients were collected through the outpatient electronic medical record system, and patients were followed up through conducting "one-stop" comprehensive management. The baseline clinical characteristics were analyzed, and the changes of metabolic indexes, treatment conditions and control rate of patients with different metabolic disorders before and after the "one-stop" outpatient management were compared.

The time interval between the first visit and the last visit was 44 (26, 60) weeks in 332 patients, whose age was (57.2±13.2) years, including 219 males (66.0%). After the "one-stop" outpatient management, fasting blood glucose (FBG) [ 6.6 (5.6, 7.9) mmol/L vs 6.3 (5.6, 6.9) mmol/L], glycosylated hemoglobin A1c (HbA1c) [ (7.2±1.5) % vs (6.6±0.8) %], low density lipoprotein cholesterol (LDL-C) [ 2.70 (1.97, 3.55) mmol/L vs 2.04 (1.66, 2.63) mmol/L] and blood uric acid (UA) [ (383.7±107.1) μmol/L vs (341.2±90.6) μmol/L] all decreased significantly (all P values<0.05). The control rates of hypertension (19.8% vs 28.2%), diabetes (45.2% vs 66.5%), hyperlipidemia (54.9% vs 87.6%) and hyperuricemia (16.7% vs 49.0%) were significantly improved after the "one-stop" outpatient management (all P values<0.05).

The "one-stop" outpatient management of cardiovascular department can significantly improve the metabolic condition and the control rate of patients with multiple metabolic disorders.

To analyze the intraocular varicella-zoster virus (VZV) infection and genetic characteristics in patients clinically diagnosed with viral anterior uveitis.

A total of 83 aqueous humor samples were collected from patients clinically diagnosed with viral anterior uveitis infection in China from June 2018 to July 2019. The positive samples infected with VZV were screened by real time polymerase chain reaction, and the single nucleotide polymorphisms on the open reading frames 22, 38 and 62 of the positive samples were amplified and analyzed. According to the gene characteristics of the amplified target fragment, the vaccine strain and wild strain (8 vaccine strains and the rest were wild strains) were identified to determine the genotype.

There were 83 patients (31 females and 52 males) with viral uveitis infection, whose mean age was 51.0 (45.5, 61.0) (range: 15-83) years,, and, of which 57.8% (48 cases) were infected with viral uveitis over 50 years of age. None of the patients had a history of varicella or herpes zoster vaccination. Of the samples of 83 patients infected with viral uveitis, 57 (68.6%) were positive for VZV. Among them, 14 were successfully amplified to obtain the target fragment gene sequences, all of which were wild strains by analysis, and belonged to Clade2 of genotype, which was the same as the VZV vaccine strain types infected by varicella and herpes zoster patients in China.

From 2018 to 2019, VZV infection in Chinese patients with viral anterior uveitis was a wild strain, and the genotype belonged to Clade2 as the vaccine strain, which was the same as the main epidemic genotype of VZV infection in Chinese patients with varicella and herpes zoster.

This article reports the diagnosis and treatment of a patient with dermatomyositis secondary to malignant tumor and tumor-related venous thromboembolism. A 70-year-old female developed rash, muscle weakness, abdominal distension and dyspnea successively, accompanied by positive anti-small ubiquitin-like modifier activating enzyme (SAE) antibody, significantly elevated carbohydrate antigen 19-9 (CA19-9), CT showed pulmonary embolism, lung space occupation, and gallbladder floor wall constriction. After PET-CT, the gallbladder was malignant. Surgical pathology confirmed gallbladder carcinoma with liver metastasis, and the final diagnosis was gallbladder carcinoma, tumor-related dermatomyositis, and acute pulmonary embolism.

This paper reports a case of extramedullary plasmacytoma (EMP) in the vagina of an elderly woman. A 56-year-old patient underwent colposcopy in a local hospital due to postmenopausal vaginal bleeding. It was found that the anterior vaginal fornix was surrounded by a painless mass, which did not involve the middle and lower vagina, cervix, uterus and bladder. It was confirmed by histology, immunohistochemistry and immunoglobulin gene analysis as solitary extramedullary plasmacytoma (SEP) of the vagina. Local radiotherapy was the main treatment for SEP. The patient did not receive radiotherapy and chemotherapy. After surgery, he was followed up every 3 months and survived after 21 months. Plasma cell tumor is a rare mature B-cell lymphoma, of which 5% to 10% appear as solitary lesions, while SEP occurring in the vagina is rare.

Asymptomatic people infected with novel coronavirus (SARS-CoV-2) are contagious, but do not have any symptoms and signs related to novel coronavirus pneumonia (COVID-19), which are difficult to detect in the population and carry the risk of epidemic transmission. Deepening the understanding of the epidemiological characteristics, influencing factors and sequelae of asymptomatic infected people will help to provide theoretical support for continuously optimizing prevention and control strategies. This article mainly reviews the relevant research on the proportion and characteristics of asymptomatic SARS-CoV-2 infected people at home and abroad. It was found that the proportion of asymptomatic infected people was higher among children; The transmission power of asymptomatic infected people is weaker than that of symptomatic infected people; Omicron has a higher percentage of asymptomatic infections than Beta and Delta; Vaccination can reduce the risk of SARS-CoV-2 infection, but vaccinated people may be more prone to symptoms after breakthrough infection; It is not yet possible to conclude that people with asymptomatic infections will experience long-term COVID-19 symptoms.

POLE mutant endometrial carcinoma accounts for 7% to 12% of the molecular typing of endometrial carcinoma. Most patients with this type are early endometrioid carcinoma. Although POLE mutant endometrial carcinoma has some unfavorable pathological features (such as poor differentiation), the overall prognosis is good, and postoperative adjuvant treatment for early patients can be considered to be downgraded. POLE mutant endometrial cancer is relatively poorly sensitive to common adjuvant chemotherapy or radiotherapy after surgery, but due to its ultra-high tumor mutation burden, relapsed or advanced patients are expected to benefit from programmed cell death receptor 1/programmed cell death receptor-ligand 1 blockade therapy. This article reviews the clinical characteristics of POLE mutant endometrial cancer and the progress of POLE gene mutation detection, which is helpful to effectively evaluate the prognosis of this type of patients, and reasonably guide patients to undergo stratified management and individualized treatment.

Urinary neutrophil gelatinase-associated lipocalin (NGAL), a biomarker of acute kidney injury, has been used in urine strip tests. However, there are limited data on its use in low-and middle-income countries, where diagnosing acute kidney injury remains a challenge. The study prospectively enrolled 250 children aged 2 to 18 years with sickle cell anemia, including 185 children hospitalized for a painful (vasoocclusive) crisis and 65 reference children followed up in usual care at a sickle cell anemia clinic. The definition of kidney injury employs a range of serum creatinine measurements and a modified definition of sickle cell anemia by the Global Organization for Improving Kidney Disease Prognosis (KDIGO). The average age of the children enrolled in school was 8.9 years, of which 42.8% were female children. Of the hospitalized children, 36.2% developed kidney injury and 3.2% died. There was a strong correlation between urine NGAL levels determined with test strips and standard enzyme-linked immunosorbent assay (0.71 in hospitalized children and 0.88 in the usual care reference population). NGAL levels were elevated during renal injury and significantly increased at all stages of injury. Adjusted for age and sex, the relative risk of kidney injury in hospitalized children undergoing high-risk strip tests (300 ng/ml and above) was 2.47, 95%CI: 1.68 to 3.61, the risk of death increased by 7.28 times, 95%CI：1.10~26.81。 In children with sickle cell anemia and acute kidney injury, urinary NGAL levels are significantly elevated and may predict the risk of death.

Acute kidney injury (AKI) is the most common and serious complication of sepsis, with high mortality and disease burden. Early prediction of AKI is key to timely intervention and ultimately improved prognosis. Prediction of AKI in patients with sepsis has been a hot topic in critical care medicine research. In recent years, due to the development of statistical theory and computer technology, machine learning has attracted the attention and recognition of clinicians. This study aims to establish and validate a predictive model based on a novel machine learning algorithm for predicting AKI occurrence in critically ill sepsis patients. This study extracted sepsis patient data from the Intensive Care Unit Medical Information Set III (MIMIC-III) database, used Boruta algorithm for feature selection, and used machine learning algorithms such as logistic regression, K-nearest neighbor algorithm (KNN), support vector machine (SVM), decision tree, random forest, extreme gradient boost (XGBoost) and artificial neural network (ANN) and ten-fold cross-validation methods to construct the model. The performance of these models was evaluated in terms of identification, calibration, and clinical application, respectively. In addition, the discrimination ability of the machine learning-based model was compared with that of the Sequential Organ Failure Assessment (SOFA) model and the customized Simplified Acute Physiological Function Score II (SAPS II) model. A total of 3 176 critically ill patients with sepsis were included for analysis, of which 2 397 (75.5%) developed AKI during hospitalization. A total of 36 variables were selected for model construction, and models such as logistic regression, KNN, SVM, decision tree, random forest, ANN, XGBoost, SOFA and SAPSⅡ score were established. The areas under the operating characteristic curve of subjects were 0.736, 0.664, 0.735, 0.749, 0.779, 0.755, 0.821, 0.646 and 0.702, respectively. Among all models, the XGBoost model has the best predictive performance in terms of identification, calibration, and clinical application. Therefore, the study considers the machine learning model to be a reliable tool to predict AKI in sepsis patients. Among them, the XGBoost model has the best predictive performance and can be used to assist clinicians in identifying high-risk patients and implementing early interventions to reduce mortality.