Background Diarrhea is a major cause of reduced growth and mortality in piglets during the suckling and weaning periods and poses a major threat to the global pig industry.Diarrhea and gut dysbiosis may in part be pre...Background Diarrhea is a major cause of reduced growth and mortality in piglets during the suckling and weaning periods and poses a major threat to the global pig industry.Diarrhea and gut dysbiosis may in part be prevented via improved early postnatal microbial colonization of the gut.To secure better postnatal gut colonization,we hypothesized that transplantation of colonic or gastric content from healthy donors to newborn recipients would prevent diarrhea in the recipients in the post-weaning period.Our objective was to examine the impact of transplanting colonic or gastric content on health and growth parameters and paraclinical parameters in recipient single-housed piglets exposed to a weaning transition and challenged with enterotoxigenic Escherichia coli(ETEC).Methods Seventy-two 1-day-old piglets were randomized to four groups:colonic microbiota transplantation(CMT,n=18),colonic content filtrate transplantation(CcFT,n=18),gastric microbiota transplantation(GMT,n=18),or saline(CON,n=18).Inoculations were given on d 2 and 3 of life,and all piglets were milk-fed until weaning(d 20)and shortly after challenged with ETEC(d 24).We assessed growth,diarrhea prevalence,ETEC concentration,organ weight,blood parameters,small intestinal morphology and histology,gut mucosal function,and microbiota composition and diversity.Results Episodes of diarrhea were seen in all groups during both the milk-and the solid-feeding phase,possibly due to stress associated with single housing.However,CcFT showed lower diarrhea prevalence on d 27,28,and 29 compared to CON(all P<0.05).CcFT also showed a lower ETEC prevalence on d 27(P<0.05).CMT showed a higher alpha diversity and a difference in beta diversity compared to CON(P<0.05).Growth and other paraclinical endpoints were similar across groups.Conclusion In conclusion,only CcFT reduced ETEC-related post-weaning diarrhea.However,the protective effect was marginal,suggesting that higher doses,more effective modalities of administration,longer treatment periods,and better donor quality should be explored by future research to optimize the protective effects of transplantation.展开更多
BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationsh...BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.AIM To study the serum BA profile detection results of patients with colonic polyps,and analyze the correlation between BA and colonic polyps.METHODS From January 1,2022,to June 1,2023,204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects,and 135 non-polyp people who underwent physical examination were chosen as the control group.Gathering all patients'clinical information,typical biochemical indicators,and BA profile.RESULTS Compared with the control group,the serum levels of taurocholic acid,glycocholic acid,glycochenodeoxycholic acid,and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group,while the content of deoxycholic acid(DCA)was lower than that in the control group(P<0.05).When colonic polyps were analyzed as subgroups,it was shown that there was a strong correlation between changes in the BA profile and polyp diameter,location,morphology,pathological kind,etc.CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps,with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content.There is a certain correlation between primary free BA and pathological parameters of polyps.展开更多
BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive orga...BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive organs,especially the colon,are rare.CASE SUMMARY An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy,resulting in a complete clinical response.One year after the initial lung cancer diagnosis,the patient presented with obstructive ileus caused by a tumor in the descending colon.An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent(SEMS).Pathologically,the tumor of the descending colon was diagnosed as lung cancer metastasis.The postoperative course was uneventful,and the patient is in good condition 13 mo after surgery,with no signs of recurrence.The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.CONCLUSION SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.展开更多
BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varice...BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varices(CV)with a high risk of severe gastrointestinal bleeding.While clear guidelines for treatment are lacking,splenectomy or splenic artery embolization are often used to treat bleeding.Splenic vein stenting has been shown to be a safe option.CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding.She was anemic with a hemoglobin of 8.0 g/dL.As a source of bleeding,CV were identified.Computed tomography scans revealed thrombotic occlusion of the splenic vein,presumably as a result of a severe acute pancreatitis 8 years prior.In a selective angiography,a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed.The hepatic venous pressure gradient was within normal range.In an interdisciplinary board,transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting,as well as coiling of the aberrant veins was discussed and successfully performed.Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV.However,a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.展开更多
Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer(OLCC) in terms of both palliative treatment and bridge-to-surgery(BTS). Notably, many studies have convin...Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer(OLCC) in terms of both palliative treatment and bridge-to-surgery(BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in shortterm outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.展开更多
Background Cold regions have long autumn and winter seasons and low ambient temperatures.When pigs are unable to adjust to the cold,oxidative damage and inflammation may develop.However,the differences between cold an...Background Cold regions have long autumn and winter seasons and low ambient temperatures.When pigs are unable to adjust to the cold,oxidative damage and inflammation may develop.However,the differences between cold and non-cold adaptation regarding glucose and lipid metabolism,gut microbiota and colonic mucosal immunological features in pigs are unknown.This study revealed the glucose and lipid metabolic responses and the dual role of gut microbiota in pigs during cold and non-cold adaptation.Moreover,the regulatory effects of dietary glucose supplements on glucose and lipid metabolism and the colonic mucosal barrier were evaluated in cold-exposed pigs.Results Cold and non-cold-adapted models were established by Min and Yorkshire pigs.Our results exhibited that cold exposure induced glucose overconsumption in non-cold-adapted pig models(Yorkshire pigs),decreasing plasma glucose concentrations.In this case,cold exposure enhanced the ATGL and CPT-1αexpression to promote liver lipolysis and fatty acid oxidation.Meanwhile,the two probiotics(Collinsella and Bifidobacterium)depletion and the enrichment of two pathogens(Sutterella and Escherichia-Shigella)in colonic microbiota are not conducive to colonic mucosal immunity.However,glucagon-mediated hepatic glycogenolysis in cold-adapted pig models(Min pigs)maintained the stability of glucose homeostasis during cold exposure.It contributed to the gut microbiota(including the enrichment of the Rikenellaceae RC9 gut group,[Eubacterium]coprostanoligenes group and WCHB1-41)that favored cold-adapted metabolism.Conclusions The results of both models indicate that the gut microbiota during cold adaptation contributes to the protection of the colonic mucosa.During non-cold adaptation,cold-induced glucose overconsumption promotes thermogenesis through lipolysis,but interferes with the gut microbiome and colonic mucosal immunity.Furthermore,glucagon-mediated hepatic glycogenolysis contributes to glucose homeostasis during cold exposure.展开更多
BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a def...BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a deformable self-assembled magnetic anastomosis ring(DSAMAR)for colonic anastomosis for use in single-approach operation and evaluate its feasibility and safety through animal experiments.METHODS The animal model for colonic stenosis was prepared by partial colonic ligation in eight beagles.The magnetic compression anastomosis of their colonic stricture was performed by endoscopically assisted transanal implantation of the DSAMAR.The anastomotic specimen,obtained 2 wk after the operation,was observed by both the naked eye and a light microscope.RESULTS The DSAMAR was successfully inserted into the proximal end of colon stenosis through the anus.The DSAMAR of seven dogs was successfully transformed into rings,while that of the remaining dog was removed after the first deformation failed.The rings were successfully retransformed after optimization.All animals underwent colonic anastomosis using the DSAMAR.No device-related or procedure-related adverse events were observed.The colostomy specimens of the experimental dogs were obtained 2 wk after the operation.Both gross and histological observations showed good anastomotic healing.CONCLUSION The DSAMAR is a safe and feasible option for the treatment of colon stenosis.Its specific deformation and selfassembly capability maximize the applicability of the minimally invasive treatment.展开更多
The major mortality factor relevant to the intestinal tract is the growth of tumorous cells(polyps)in various parts.More specifically,colonic polyps have a high rate and are recognized as a precursor of colon cancer g...The major mortality factor relevant to the intestinal tract is the growth of tumorous cells(polyps)in various parts.More specifically,colonic polyps have a high rate and are recognized as a precursor of colon cancer growth.Endoscopy is the conventional technique for detecting colon polyps,and considerable research has proved that automated diagnosis of image regions that might have polyps within the colon might be used to help experts for decreasing the polyp miss rate.The automated diagnosis of polyps in a computer-aided diagnosis(CAD)method is implemented using statistical analysis.Nowadays,Deep Learning,particularly throughConvolution Neural networks(CNN),is broadly employed to allowthe extraction of representative features.This manuscript devises a new Northern Goshawk Optimization with Transfer Learning Model for Colonic Polyp Detection and Classification(NGOTL-CPDC)model.The NGOTL-CPDC technique aims to investigate endoscopic images for automated colonic polyp detection.To accomplish this,the NGOTL-CPDC technique comprises of adaptive bilateral filtering(ABF)technique as a noise removal process and image pre-processing step.Besides,the NGOTL-CPDC model applies the Faster SqueezeNet model for feature extraction purposes in which the hyperparameter tuning process is performed using the NGO optimizer.Finally,the fuzzy Hopfield neural network(FHNN)method can be employed for colonic poly detection and classification.A widespread simulation analysis is carried out to ensure the improved outcomes of the NGOTL-CPDC model.The comparison study demonstrates the enhancements of the NGOTL-CPDC model on the colonic polyp classification process on medical test images.展开更多
BACKGROUND Since fat does not transmit electrical energy well,delayed perforation and postpolypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma.The endoscopic s...BACKGROUND Since fat does not transmit electrical energy well,delayed perforation and postpolypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma.The endoscopic submucosal dissection(ESD)technique concentrates electrical energy conducts to the submucosa,not the adipose tissue.This helps to minimize electrical thermal injury,especially in the case of large colonic lipomas.In rare cases,such as colonic lipomas accompanied by mucosal lesions,it is difficult for endoscopists to decide how to safely remove them.CASE SUMMARY A 78-year-old man underwent colonoscopy for colorectal cancer screening.During colonoscopy,a yellowish submucosal tumor with positive cushion sign was observed in the ascending colon measuring about 4.5 cm.A nodular mucosal lesion of about 2.5 cm was observed on the mucosal surface of the lipoma.The lipoma was so large that it occupied much of the inside of the colon,making it difficult to see the entire laterally spreading tumor(LST)at once.The LST was confined to the surface of the lipoma,which had a semipedunculated shape with a wide neck.The margin of the LST was not observed at the neck of the lipoma.ESD was performed and the colonic lipoma with the LST was successfully removed without complications.After 3 d of hospitalization,the patient was discharged without any symptoms.The final pathology report showed that the lesion consisted of submucosal lipoma and tubulovillous adenoma with lowgrade dysplasia.CONCLUSION ESD is effective and safe for treating a large colonic lipoma with an LST by minimizing electrical thermal injury.展开更多
BACKGROUND Ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological ...BACKGROUND Ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological features.Currently,the literature reports only two anecdotal cases of malignant transformation of colonic ectopic pancreas.CASE SUMMARY We present a case of an 81-year-old patient presenting with anemia,with right colonic neoplasia and carbohydrate antigen 19-9 above the normal values.She underwent laparoscopic right hemicolectomy.The final histology was consistent with a primitive adenocarcinoma with ductal morphology and solid-predominant growth pattern.Benign ectopic pancreatic tissue was absent in the surgical specimen.CONCLUSION The case describes a very rare complete degeneration of a colonic ectopic pancreatic tissue.However,the absence of benign ectopic pancreatic tissue in the surgical specimen is suggestive of the first description of a primitive ductal adenocarcinoma of the colon.展开更多
Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity, associated with fibrosis and inflammatory reaction. The most common atypical locations are the gastrointestina...Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity, associated with fibrosis and inflammatory reaction. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, as well as abdominal surgical scars. Its diagnosis is still very difficult, especially when it manifests itself as an acute large bowel obstruction. We report the rare case of a 41-year-old patient diagnosed with acute colonic obstruction following a rectal tumor. She had undergone colonostomy even though colonoscopy biopsies were nonspecific, and a computed tomography (CT) scan was requested. It showed an adnexal heterogenous mass, therefore the patient had a laparotomy and a subtotal hysterectomy with bilateral salpingo-oophorectomy and a biopsy of the recto-colonic hinge. Histologic examination revealed a diagnosis of rectal endometriosis. The purpose of this work is to report a rare case of colonic endometriosis responsible for an acute large bowel obstruction.展开更多
BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual dec...BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual decompression and subtotal colectomy.AIM To compare the peri-operative outcomes of IOCL to other procedures.METHODS Electronic databases were searched for articles employing IOCL from inception till July 13,2020.Odds ratio and weighted mean differences(WMD)were estimated for dichotomous and continuous outcomes respectively.Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.RESULTS Of 28 studies were included in this meta-analysis,involving 1142 undergoing IOCL,and 634 other interventions.IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure,and anastomotic leak and wound infection when compared to manual decompression.There was a decreased length of hospital stay(WMD=-7.750;95%CI:-13.504 to-1.996;P=0.008)compared to manual decompression and an increased operating time.Single-arm meta-analysis found that overall mortality rates with IOCL was 4%(CI:0.03-0.05).Rates of anastomotic leak and wound infection were 3%(CI:0.02-0.04)and 12%(CI:0.09-0.16)respectively.CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures.More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.展开更多
Herein we describe an early colonic carcinoma which developed in a colonic interposition 14 years after surgery for esophageal cancer, which was successfully treated by endoscopic submucosal dissection (ESD). An 80-ye...Herein we describe an early colonic carcinoma which developed in a colonic interposition 14 years after surgery for esophageal cancer, which was successfully treated by endoscopic submucosal dissection (ESD). An 80-year-old man underwent colonic interposition between the upper esophagus and stomach after surgery for an early esophageal squamous cell carcinoma in 1994. He received a surveillance endoscopy, and a laterally-spreading tumor of granular type, approximately 20 mm in size, was identified in the colonic interposition. An endoscopic biopsy revealed moderately differentiated adenocarcinoma histologically, however, we diagnosed the lesion as an intramucosal carcinoma based on the endoscopic findings. The lesion was safely and completely removed en bloc by ESD using a bipolar knife. Histologically, the lesion was an intramucosal moderately differentiated adenocarcinoma in a tubular adenoma.展开更多
Colocolonic intussusception is an uncommon cause of intestinal obstruction in children.The most common type is idiopathic ileocolic intussusception.However,pathologic lead points occur approximately in 5%of cases.In p...Colocolonic intussusception is an uncommon cause of intestinal obstruction in children.The most common type is idiopathic ileocolic intussusception.However,pathologic lead points occur approximately in 5%of cases.In pediatric patients,Meckel’s diverticulum is the most common lead point,followed by polyps and duplication.We present a case of recurrent colocolonic intussusception which caused colonic obstruction in a 10-year-old boy.A barium enema revealed a large polypoid mass at the transverse colon.Colonoscopy showed a colonic polyp,3.5 centimeters in diameter,which was successfully removed by endoscopic polypectomy.展开更多
BACKGROUND The mechanisms underlying gastrointestinal(GI)dysmotility with ulcerative colitis(UC)have not been fully elucidated.The enteric nervous system(ENS)plays an essential role in the GI motility.As a vital neuro...BACKGROUND The mechanisms underlying gastrointestinal(GI)dysmotility with ulcerative colitis(UC)have not been fully elucidated.The enteric nervous system(ENS)plays an essential role in the GI motility.As a vital neurotransmitter in the ENS,the gas neurotransmitter nitric oxide(NO)may impact the colonic motility.In this study,dextran sulfate sodium(DSS)-induced UC rat model was used for investigating the effects of NO by examining the effects of rate-limiting enzyme nitric oxide synthase(NOS)changes on the colonic motility as well as the role of the ENS in the colonic motility during UC.AIM To reveal the relationship between the effects of NOS expression changes in NOS-containing nitrergic neurons and the colonic motility in a rat UC model.METHODS Male rats(n=8/each group)were randomly divided into a control(CG),a UC group(EG1),a UC+thrombin derived polypeptide 508 trifluoroacetic acid(TP508TFA;an NOS agonist)group(EG2),and a UC+NG-monomethyl-L-arginine monoacetate(L-NMMA;an NOS inhibitor)group(EG3).UC was induced by administering 5.5%DSS in drinking water without any other treatment(EG1),while the EG2 and EG3 were gavaged with TP508 TFA and L-NMMA,respectively.The disease activity index(DAI)and histological assessment were recorded for each group,whereas the changes in the proportion of colonic nitrergic neurons were counted using immunofluorescence histochemical staining,Western blot,and enzyme linked immunosorbent assay,respectively.In addition,the contractile tension changes in the circular and longitudinal muscles of the rat colon were investigated in vitro using an organ bath system.RESULTS The proportion of NOS-positive neurons within the colonic myenteric plexus(MP),the relative expression of NOS,and the NOS concentration in serum and colonic tissues were significantly elevated in EG1,EG2,and EG3 compared with CG rats.In UC rats,stimulation with agonists and inhibitors led to variable degrees of increase or decrease for each indicator in the EG2 and EG3.When the rats in EGs developed UC,the mean contraction tension of the colonic smooth muscle detected in vitro was higher in the EG1,EG2,and EG3 than in the CG group.Compared with the EG1,the contraction amplitude and mean contraction tension of the circular and longitudinal muscles of the colon in the EG2 and EG3 were enhanced and attenuated,respectively.Thus,during UC,regulation of the expression of NOS within the MP improved the intestinal motility,thereby favoring the recovery of intestinal functions.CONCLUSION In UC rats,an increased number of nitrergic neurons in the colonic MP leads to the attenuation of colonic motor function.To intervene NOS activity might modulate the function of nitrergic neurons in the colonic MP and prevent colonic motor dysfunction.These results might provide clues for a novel approach to alleviate diarrhea symptoms of UC patients.展开更多
The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal area.It is estimated that patients with CD have one in four chance of undergoing surgery during their life.As surgery...The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal area.It is estimated that patients with CD have one in four chance of undergoing surgery during their life.As surgery in ulcerative colitis ultimately cures the disease,in CD,regardless of the extent of bowel removed,the risk of disease recurrence is as high as 40%.In elective surgery,management of isolated Crohn’s colitis continues to evolve.Depending on the type of surgery performed,colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence.The elective surgical treatment of colonic CD is strictly dependent on the localization of disease,and the choice of the procedure is dependent of the extent of colonic involvement and previous resection.The most common surgical options in colonic CD are total proctocolectomy(TPC)with permanent ileostomy,segmental bowel resection,subtotal colectomy.TPC completely removes all colonic and rectal disease and avoids the use of a potentially diseased anus.We will review current options for the elective surgical treatment of colonic CD,based on the current literature and our own personal experience.展开更多
BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To...BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.METHODS We conducted a single-center retrospective cohort study.Patients who underwent colonoscopy within 24 h of presentation(early group)were compared with those who underwent colonoscopy beyond 24 h of presentation(elective group).The primary outcome was the length of hospital stay,and secondary outcomes were the identification of stigmata of recent hemorrhage(SRH),rebleeding,red blood cell transfusion more than 4 units,and interventional radiology and abdominal surgery after colonoscopy.RESULTS We identified 574 CDH cases.Patients were divided into the early(n=328)and elective(n=226)groups.After propensity score matching,191 pairs were generated.The length of hospital stay did not significantly differ between the two groups(early group vs elective group;median,7 vs 8 d;P=0.10).The early group had a significantly high identification of SRH(risk difference,11.6%;95%CI:2.7 to 20.3;P=0.02).No significant differences were found in the rebleeding(risk difference,4.7%;95%CI:-4.1 to 13.5;P=0.35),red blood cell transfusion more than 4 units(risk difference,1.6%;95%CI:-7.5 to 10.6;P=0.82),and interventional radiology and abdominal surgery rate after colonoscopy(risk difference,0.5%;95%CI:-2.2 to 3.2;P=1.00).CONCLUSION Early colonoscopy within 24 h,on arrival for CDH,could not improve the length of hospital stay.展开更多
INTRODUCTIONThe treatment of human epithelial malignancies islimited by drug resistance and toxic and side effects,which results in the failure in the treatment ofmajority of advanced cancer victims.To seek for anew,a...INTRODUCTIONThe treatment of human epithelial malignancies islimited by drug resistance and toxic and side effects,which results in the failure in the treatment ofmajority of advanced cancer victims.To seek for anew,and specific antineoplastic therapy willprovide hope for tumor treatment.Althoughdisordered intermediary metabolism in cancer cellshas been known for many years,much of the展开更多
AIM:To make a retrospective analysis of endoscopy findings and clinicopathologic characteristics of colonic schistosomiasis in order to further improve our understanding of the disease and decrease its misdiagnosis. M...AIM:To make a retrospective analysis of endoscopy findings and clinicopathologic characteristics of colonic schistosomiasis in order to further improve our understanding of the disease and decrease its misdiagnosis. METHODS:Endoscopy findings and clinicopathologic characteristics of 46 intestinal schistosomiasis patients were retrospectively analyzed.All the patients underwent colonoscopy and all biopsy specimens stained with hematoxylin and eosin were observed under a light microscope. RESULTS:Of the 46 colonic schistosomiasis patients,1 was diagnosed as acute schistosomal colitis,16 as chronic schistosomal colitis and 29 as chronic active schistosomal colitis according to their endoscopic findings and pathology.Not all patients were suspected of or diagnosed as colonic schistosomiasis.Of the 12 misdiagnosed patients,4 were misdiagnosed as ulcerativecolitis,1 as Crohn's disease,and 7 as ischemic colitis.The segments of rectum and sigmoid colon were involved in 29 patients(63.0%) .Intact Schistosoma ova were deposited in colonic mucosa accompanying infiltration of eosinocytes,lymphocytes,and plasma cells in acute schistosomal colitis patients.Submucosal fibrosis was found in chronic schistosomal colitis patients.Among the 17 patients with a signal polyp,hyperplastic polyp,canalicular adenoma with a low-grade intraepithelial neoplastic change,tubulovillous adenoma with a highgrade intraepithelial neoplastic change were observed in 10,5,and 2 patients,respectively.Eight out of the 46 patients were diagnosed as colonic carcinoma. CONCLUSION:Endoscopy contributes to the diagnosis of colonic schistosomiasis although it is nonspecific. A correct diagnosis of colonic schistosomiasis can be established by endoscopy in combination with its clinicopathologic characteristics.展开更多
基金support by European Union's Horizon 2020 Research and Innovation Program under Grant Agreement No.862829,project AVANT-Alternatives to Veterinary ANTimicrobials.
文摘Background Diarrhea is a major cause of reduced growth and mortality in piglets during the suckling and weaning periods and poses a major threat to the global pig industry.Diarrhea and gut dysbiosis may in part be prevented via improved early postnatal microbial colonization of the gut.To secure better postnatal gut colonization,we hypothesized that transplantation of colonic or gastric content from healthy donors to newborn recipients would prevent diarrhea in the recipients in the post-weaning period.Our objective was to examine the impact of transplanting colonic or gastric content on health and growth parameters and paraclinical parameters in recipient single-housed piglets exposed to a weaning transition and challenged with enterotoxigenic Escherichia coli(ETEC).Methods Seventy-two 1-day-old piglets were randomized to four groups:colonic microbiota transplantation(CMT,n=18),colonic content filtrate transplantation(CcFT,n=18),gastric microbiota transplantation(GMT,n=18),or saline(CON,n=18).Inoculations were given on d 2 and 3 of life,and all piglets were milk-fed until weaning(d 20)and shortly after challenged with ETEC(d 24).We assessed growth,diarrhea prevalence,ETEC concentration,organ weight,blood parameters,small intestinal morphology and histology,gut mucosal function,and microbiota composition and diversity.Results Episodes of diarrhea were seen in all groups during both the milk-and the solid-feeding phase,possibly due to stress associated with single housing.However,CcFT showed lower diarrhea prevalence on d 27,28,and 29 compared to CON(all P<0.05).CcFT also showed a lower ETEC prevalence on d 27(P<0.05).CMT showed a higher alpha diversity and a difference in beta diversity compared to CON(P<0.05).Growth and other paraclinical endpoints were similar across groups.Conclusion In conclusion,only CcFT reduced ETEC-related post-weaning diarrhea.However,the protective effect was marginal,suggesting that higher doses,more effective modalities of administration,longer treatment periods,and better donor quality should be explored by future research to optimize the protective effects of transplantation.
文摘BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.AIM To study the serum BA profile detection results of patients with colonic polyps,and analyze the correlation between BA and colonic polyps.METHODS From January 1,2022,to June 1,2023,204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects,and 135 non-polyp people who underwent physical examination were chosen as the control group.Gathering all patients'clinical information,typical biochemical indicators,and BA profile.RESULTS Compared with the control group,the serum levels of taurocholic acid,glycocholic acid,glycochenodeoxycholic acid,and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group,while the content of deoxycholic acid(DCA)was lower than that in the control group(P<0.05).When colonic polyps were analyzed as subgroups,it was shown that there was a strong correlation between changes in the BA profile and polyp diameter,location,morphology,pathological kind,etc.CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps,with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content.There is a certain correlation between primary free BA and pathological parameters of polyps.
文摘BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive organs,especially the colon,are rare.CASE SUMMARY An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy,resulting in a complete clinical response.One year after the initial lung cancer diagnosis,the patient presented with obstructive ileus caused by a tumor in the descending colon.An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent(SEMS).Pathologically,the tumor of the descending colon was diagnosed as lung cancer metastasis.The postoperative course was uneventful,and the patient is in good condition 13 mo after surgery,with no signs of recurrence.The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.CONCLUSION SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.
文摘BACKGROUND Splenic vein thrombosis is a known complication of pancreatitis.It can lead to increased blood flow through mesenteric collaterals.This segmental hypertension may result in the development of colonic varices(CV)with a high risk of severe gastrointestinal bleeding.While clear guidelines for treatment are lacking,splenectomy or splenic artery embolization are often used to treat bleeding.Splenic vein stenting has been shown to be a safe option.CASE SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding.She was anemic with a hemoglobin of 8.0 g/dL.As a source of bleeding,CV were identified.Computed tomography scans revealed thrombotic occlusion of the splenic vein,presumably as a result of a severe acute pancreatitis 8 years prior.In a selective angiography,a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed.The hepatic venous pressure gradient was within normal range.In an interdisciplinary board,transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting,as well as coiling of the aberrant veins was discussed and successfully performed.Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.CONCLUSION Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV.However,a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.
文摘Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer(OLCC) in terms of both palliative treatment and bridge-to-surgery(BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in shortterm outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.
基金supported by the National Key R&D Program of China(2021YFD1300403)the Major Program of Heilongjiang Province of China(2021ZX12B08-02).
文摘Background Cold regions have long autumn and winter seasons and low ambient temperatures.When pigs are unable to adjust to the cold,oxidative damage and inflammation may develop.However,the differences between cold and non-cold adaptation regarding glucose and lipid metabolism,gut microbiota and colonic mucosal immunological features in pigs are unknown.This study revealed the glucose and lipid metabolic responses and the dual role of gut microbiota in pigs during cold and non-cold adaptation.Moreover,the regulatory effects of dietary glucose supplements on glucose and lipid metabolism and the colonic mucosal barrier were evaluated in cold-exposed pigs.Results Cold and non-cold-adapted models were established by Min and Yorkshire pigs.Our results exhibited that cold exposure induced glucose overconsumption in non-cold-adapted pig models(Yorkshire pigs),decreasing plasma glucose concentrations.In this case,cold exposure enhanced the ATGL and CPT-1αexpression to promote liver lipolysis and fatty acid oxidation.Meanwhile,the two probiotics(Collinsella and Bifidobacterium)depletion and the enrichment of two pathogens(Sutterella and Escherichia-Shigella)in colonic microbiota are not conducive to colonic mucosal immunity.However,glucagon-mediated hepatic glycogenolysis in cold-adapted pig models(Min pigs)maintained the stability of glucose homeostasis during cold exposure.It contributed to the gut microbiota(including the enrichment of the Rikenellaceae RC9 gut group,[Eubacterium]coprostanoligenes group and WCHB1-41)that favored cold-adapted metabolism.Conclusions The results of both models indicate that the gut microbiota during cold adaptation contributes to the protection of the colonic mucosa.During non-cold adaptation,cold-induced glucose overconsumption promotes thermogenesis through lipolysis,but interferes with the gut microbiome and colonic mucosal immunity.Furthermore,glucagon-mediated hepatic glycogenolysis contributes to glucose homeostasis during cold exposure.
基金the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07the Key Research&Development Program-Social Development of Shaanxi Province of China,No.2023-YBSF-247.
文摘BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a deformable self-assembled magnetic anastomosis ring(DSAMAR)for colonic anastomosis for use in single-approach operation and evaluate its feasibility and safety through animal experiments.METHODS The animal model for colonic stenosis was prepared by partial colonic ligation in eight beagles.The magnetic compression anastomosis of their colonic stricture was performed by endoscopically assisted transanal implantation of the DSAMAR.The anastomotic specimen,obtained 2 wk after the operation,was observed by both the naked eye and a light microscope.RESULTS The DSAMAR was successfully inserted into the proximal end of colon stenosis through the anus.The DSAMAR of seven dogs was successfully transformed into rings,while that of the remaining dog was removed after the first deformation failed.The rings were successfully retransformed after optimization.All animals underwent colonic anastomosis using the DSAMAR.No device-related or procedure-related adverse events were observed.The colostomy specimens of the experimental dogs were obtained 2 wk after the operation.Both gross and histological observations showed good anastomotic healing.CONCLUSION The DSAMAR is a safe and feasible option for the treatment of colon stenosis.Its specific deformation and selfassembly capability maximize the applicability of the minimally invasive treatment.
文摘The major mortality factor relevant to the intestinal tract is the growth of tumorous cells(polyps)in various parts.More specifically,colonic polyps have a high rate and are recognized as a precursor of colon cancer growth.Endoscopy is the conventional technique for detecting colon polyps,and considerable research has proved that automated diagnosis of image regions that might have polyps within the colon might be used to help experts for decreasing the polyp miss rate.The automated diagnosis of polyps in a computer-aided diagnosis(CAD)method is implemented using statistical analysis.Nowadays,Deep Learning,particularly throughConvolution Neural networks(CNN),is broadly employed to allowthe extraction of representative features.This manuscript devises a new Northern Goshawk Optimization with Transfer Learning Model for Colonic Polyp Detection and Classification(NGOTL-CPDC)model.The NGOTL-CPDC technique aims to investigate endoscopic images for automated colonic polyp detection.To accomplish this,the NGOTL-CPDC technique comprises of adaptive bilateral filtering(ABF)technique as a noise removal process and image pre-processing step.Besides,the NGOTL-CPDC model applies the Faster SqueezeNet model for feature extraction purposes in which the hyperparameter tuning process is performed using the NGO optimizer.Finally,the fuzzy Hopfield neural network(FHNN)method can be employed for colonic poly detection and classification.A widespread simulation analysis is carried out to ensure the improved outcomes of the NGOTL-CPDC model.The comparison study demonstrates the enhancements of the NGOTL-CPDC model on the colonic polyp classification process on medical test images.
文摘BACKGROUND Since fat does not transmit electrical energy well,delayed perforation and postpolypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma.The endoscopic submucosal dissection(ESD)technique concentrates electrical energy conducts to the submucosa,not the adipose tissue.This helps to minimize electrical thermal injury,especially in the case of large colonic lipomas.In rare cases,such as colonic lipomas accompanied by mucosal lesions,it is difficult for endoscopists to decide how to safely remove them.CASE SUMMARY A 78-year-old man underwent colonoscopy for colorectal cancer screening.During colonoscopy,a yellowish submucosal tumor with positive cushion sign was observed in the ascending colon measuring about 4.5 cm.A nodular mucosal lesion of about 2.5 cm was observed on the mucosal surface of the lipoma.The lipoma was so large that it occupied much of the inside of the colon,making it difficult to see the entire laterally spreading tumor(LST)at once.The LST was confined to the surface of the lipoma,which had a semipedunculated shape with a wide neck.The margin of the LST was not observed at the neck of the lipoma.ESD was performed and the colonic lipoma with the LST was successfully removed without complications.After 3 d of hospitalization,the patient was discharged without any symptoms.The final pathology report showed that the lesion consisted of submucosal lipoma and tubulovillous adenoma with lowgrade dysplasia.CONCLUSION ESD is effective and safe for treating a large colonic lipoma with an LST by minimizing electrical thermal injury.
文摘BACKGROUND Ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological features.Currently,the literature reports only two anecdotal cases of malignant transformation of colonic ectopic pancreas.CASE SUMMARY We present a case of an 81-year-old patient presenting with anemia,with right colonic neoplasia and carbohydrate antigen 19-9 above the normal values.She underwent laparoscopic right hemicolectomy.The final histology was consistent with a primitive adenocarcinoma with ductal morphology and solid-predominant growth pattern.Benign ectopic pancreatic tissue was absent in the surgical specimen.CONCLUSION The case describes a very rare complete degeneration of a colonic ectopic pancreatic tissue.However,the absence of benign ectopic pancreatic tissue in the surgical specimen is suggestive of the first description of a primitive ductal adenocarcinoma of the colon.
文摘Endometriosis is defined as the presence of endometrial tissue that is located outside the uterine cavity, associated with fibrosis and inflammatory reaction. The most common atypical locations are the gastrointestinal tract, urinary tract, lung, as well as abdominal surgical scars. Its diagnosis is still very difficult, especially when it manifests itself as an acute large bowel obstruction. We report the rare case of a 41-year-old patient diagnosed with acute colonic obstruction following a rectal tumor. She had undergone colonostomy even though colonoscopy biopsies were nonspecific, and a computed tomography (CT) scan was requested. It showed an adnexal heterogenous mass, therefore the patient had a laparotomy and a subtotal hysterectomy with bilateral salpingo-oophorectomy and a biopsy of the recto-colonic hinge. Histologic examination revealed a diagnosis of rectal endometriosis. The purpose of this work is to report a rare case of colonic endometriosis responsible for an acute large bowel obstruction.
文摘BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual decompression and subtotal colectomy.AIM To compare the peri-operative outcomes of IOCL to other procedures.METHODS Electronic databases were searched for articles employing IOCL from inception till July 13,2020.Odds ratio and weighted mean differences(WMD)were estimated for dichotomous and continuous outcomes respectively.Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.RESULTS Of 28 studies were included in this meta-analysis,involving 1142 undergoing IOCL,and 634 other interventions.IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure,and anastomotic leak and wound infection when compared to manual decompression.There was a decreased length of hospital stay(WMD=-7.750;95%CI:-13.504 to-1.996;P=0.008)compared to manual decompression and an increased operating time.Single-arm meta-analysis found that overall mortality rates with IOCL was 4%(CI:0.03-0.05).Rates of anastomotic leak and wound infection were 3%(CI:0.02-0.04)and 12%(CI:0.09-0.16)respectively.CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures.More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.
文摘Herein we describe an early colonic carcinoma which developed in a colonic interposition 14 years after surgery for esophageal cancer, which was successfully treated by endoscopic submucosal dissection (ESD). An 80-year-old man underwent colonic interposition between the upper esophagus and stomach after surgery for an early esophageal squamous cell carcinoma in 1994. He received a surveillance endoscopy, and a laterally-spreading tumor of granular type, approximately 20 mm in size, was identified in the colonic interposition. An endoscopic biopsy revealed moderately differentiated adenocarcinoma histologically, however, we diagnosed the lesion as an intramucosal carcinoma based on the endoscopic findings. The lesion was safely and completely removed en bloc by ESD using a bipolar knife. Histologically, the lesion was an intramucosal moderately differentiated adenocarcinoma in a tubular adenoma.
基金Supported by Faculty of Medicine,Siriraj Hospital,Mahidol University,Bangkok 10700,Thailand
文摘Colocolonic intussusception is an uncommon cause of intestinal obstruction in children.The most common type is idiopathic ileocolic intussusception.However,pathologic lead points occur approximately in 5%of cases.In pediatric patients,Meckel’s diverticulum is the most common lead point,followed by polyps and duplication.We present a case of recurrent colocolonic intussusception which caused colonic obstruction in a 10-year-old boy.A barium enema revealed a large polypoid mass at the transverse colon.Colonoscopy showed a colonic polyp,3.5 centimeters in diameter,which was successfully removed by endoscopic polypectomy.
基金Supported by National Natural Science Foundation of China,No.31971112Natural Science Foundation of Liaoning Province,No.2021-MS-330Innovation Capability Support Program of Shaanxi,No.2021TD-57.
文摘BACKGROUND The mechanisms underlying gastrointestinal(GI)dysmotility with ulcerative colitis(UC)have not been fully elucidated.The enteric nervous system(ENS)plays an essential role in the GI motility.As a vital neurotransmitter in the ENS,the gas neurotransmitter nitric oxide(NO)may impact the colonic motility.In this study,dextran sulfate sodium(DSS)-induced UC rat model was used for investigating the effects of NO by examining the effects of rate-limiting enzyme nitric oxide synthase(NOS)changes on the colonic motility as well as the role of the ENS in the colonic motility during UC.AIM To reveal the relationship between the effects of NOS expression changes in NOS-containing nitrergic neurons and the colonic motility in a rat UC model.METHODS Male rats(n=8/each group)were randomly divided into a control(CG),a UC group(EG1),a UC+thrombin derived polypeptide 508 trifluoroacetic acid(TP508TFA;an NOS agonist)group(EG2),and a UC+NG-monomethyl-L-arginine monoacetate(L-NMMA;an NOS inhibitor)group(EG3).UC was induced by administering 5.5%DSS in drinking water without any other treatment(EG1),while the EG2 and EG3 were gavaged with TP508 TFA and L-NMMA,respectively.The disease activity index(DAI)and histological assessment were recorded for each group,whereas the changes in the proportion of colonic nitrergic neurons were counted using immunofluorescence histochemical staining,Western blot,and enzyme linked immunosorbent assay,respectively.In addition,the contractile tension changes in the circular and longitudinal muscles of the rat colon were investigated in vitro using an organ bath system.RESULTS The proportion of NOS-positive neurons within the colonic myenteric plexus(MP),the relative expression of NOS,and the NOS concentration in serum and colonic tissues were significantly elevated in EG1,EG2,and EG3 compared with CG rats.In UC rats,stimulation with agonists and inhibitors led to variable degrees of increase or decrease for each indicator in the EG2 and EG3.When the rats in EGs developed UC,the mean contraction tension of the colonic smooth muscle detected in vitro was higher in the EG1,EG2,and EG3 than in the CG group.Compared with the EG1,the contraction amplitude and mean contraction tension of the circular and longitudinal muscles of the colon in the EG2 and EG3 were enhanced and attenuated,respectively.Thus,during UC,regulation of the expression of NOS within the MP improved the intestinal motility,thereby favoring the recovery of intestinal functions.CONCLUSION In UC rats,an increased number of nitrergic neurons in the colonic MP leads to the attenuation of colonic motor function.To intervene NOS activity might modulate the function of nitrergic neurons in the colonic MP and prevent colonic motor dysfunction.These results might provide clues for a novel approach to alleviate diarrhea symptoms of UC patients.
文摘The most common localization for intestinal Crohn’s disease(CD)is the terminal ileum and ileocecal area.It is estimated that patients with CD have one in four chance of undergoing surgery during their life.As surgery in ulcerative colitis ultimately cures the disease,in CD,regardless of the extent of bowel removed,the risk of disease recurrence is as high as 40%.In elective surgery,management of isolated Crohn’s colitis continues to evolve.Depending on the type of surgery performed,colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence.The elective surgical treatment of colonic CD is strictly dependent on the localization of disease,and the choice of the procedure is dependent of the extent of colonic involvement and previous resection.The most common surgical options in colonic CD are total proctocolectomy(TPC)with permanent ileostomy,segmental bowel resection,subtotal colectomy.TPC completely removes all colonic and rectal disease and avoids the use of a potentially diseased anus.We will review current options for the elective surgical treatment of colonic CD,based on the current literature and our own personal experience.
文摘BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.METHODS We conducted a single-center retrospective cohort study.Patients who underwent colonoscopy within 24 h of presentation(early group)were compared with those who underwent colonoscopy beyond 24 h of presentation(elective group).The primary outcome was the length of hospital stay,and secondary outcomes were the identification of stigmata of recent hemorrhage(SRH),rebleeding,red blood cell transfusion more than 4 units,and interventional radiology and abdominal surgery after colonoscopy.RESULTS We identified 574 CDH cases.Patients were divided into the early(n=328)and elective(n=226)groups.After propensity score matching,191 pairs were generated.The length of hospital stay did not significantly differ between the two groups(early group vs elective group;median,7 vs 8 d;P=0.10).The early group had a significantly high identification of SRH(risk difference,11.6%;95%CI:2.7 to 20.3;P=0.02).No significant differences were found in the rebleeding(risk difference,4.7%;95%CI:-4.1 to 13.5;P=0.35),red blood cell transfusion more than 4 units(risk difference,1.6%;95%CI:-7.5 to 10.6;P=0.82),and interventional radiology and abdominal surgery rate after colonoscopy(risk difference,0.5%;95%CI:-2.2 to 3.2;P=1.00).CONCLUSION Early colonoscopy within 24 h,on arrival for CDH,could not improve the length of hospital stay.
基金the Applied Science Foundation of Jiangsu Province,China,No.BJ97071
文摘INTRODUCTIONThe treatment of human epithelial malignancies islimited by drug resistance and toxic and side effects,which results in the failure in the treatment ofmajority of advanced cancer victims.To seek for anew,and specific antineoplastic therapy willprovide hope for tumor treatment.Althoughdisordered intermediary metabolism in cancer cellshas been known for many years,much of the
文摘AIM:To make a retrospective analysis of endoscopy findings and clinicopathologic characteristics of colonic schistosomiasis in order to further improve our understanding of the disease and decrease its misdiagnosis. METHODS:Endoscopy findings and clinicopathologic characteristics of 46 intestinal schistosomiasis patients were retrospectively analyzed.All the patients underwent colonoscopy and all biopsy specimens stained with hematoxylin and eosin were observed under a light microscope. RESULTS:Of the 46 colonic schistosomiasis patients,1 was diagnosed as acute schistosomal colitis,16 as chronic schistosomal colitis and 29 as chronic active schistosomal colitis according to their endoscopic findings and pathology.Not all patients were suspected of or diagnosed as colonic schistosomiasis.Of the 12 misdiagnosed patients,4 were misdiagnosed as ulcerativecolitis,1 as Crohn's disease,and 7 as ischemic colitis.The segments of rectum and sigmoid colon were involved in 29 patients(63.0%) .Intact Schistosoma ova were deposited in colonic mucosa accompanying infiltration of eosinocytes,lymphocytes,and plasma cells in acute schistosomal colitis patients.Submucosal fibrosis was found in chronic schistosomal colitis patients.Among the 17 patients with a signal polyp,hyperplastic polyp,canalicular adenoma with a low-grade intraepithelial neoplastic change,tubulovillous adenoma with a highgrade intraepithelial neoplastic change were observed in 10,5,and 2 patients,respectively.Eight out of the 46 patients were diagnosed as colonic carcinoma. CONCLUSION:Endoscopy contributes to the diagnosis of colonic schistosomiasis although it is nonspecific. A correct diagnosis of colonic schistosomiasis can be established by endoscopy in combination with its clinicopathologic characteristics.
