BACKGROUND The procedure for microwave endometrial ablation(MEA)follows established MEA practice guidelines but requires hysteroscopic observation of the uterine lumen before and after MEA.When a luminal uterine lesio...BACKGROUND The procedure for microwave endometrial ablation(MEA)follows established MEA practice guidelines but requires hysteroscopic observation of the uterine lumen before and after MEA.When a luminal uterine lesion is recognized,its removal requires preoperative dilation of the cervix because the outer diameter of a conventional rigid hysteroscope is 8.7 mm.Recently,a fully disposable rigid hysteroscope(LiNA OperaScope^(TM))with a narrow diameter(4.4 mm)and forceps capable of extracting endometrial lesions has become available.CASE SUMMARY Here,we report a case of heavy menstrual bleeding(HMB)complicated by endometrial polyps where MEA was performed after removing endometrial polyps using the LiNA OperaScope^(TM) device.A 48-year-old woman with three prior pregnancies and three deliveries was referred to our hospital for further examination and treatment after being diagnosed with HMB 2 years earlier.The patient underwent MEA following endometrial polypectomy using LiNA OperaScope^(TM).After MEA,endometrial cauterization was again examined using the LiNA OperaScope^(TM),and the procedure was completed.No preoperative cervical dilation was performed.The patient’s clinical course was favorable,and she was discharged 3 h after surgery.One month after surgery,menstruation resumed,and both HMB and dysmenorrhea improved markedly from 10 preoperatively to 1 postoperatively,as assessed subjectively using the visual analog scale.The patient’s postoperative course was uneventful with no complic-ations.CONCLUSION LiNA OperaScope^(TM) can be a minimally invasive treatment for MEA of HMB with uterine lumen lesions.展开更多
Objective:To explore the effect of whole-process management model in nursing management of endometrial polyp day surgery.Methods:266 patients that underwent endometrial polyp day surgery from January to December 2022 ...Objective:To explore the effect of whole-process management model in nursing management of endometrial polyp day surgery.Methods:266 patients that underwent endometrial polyp day surgery from January to December 2022 were selected for this study,and they were separated into an observation group(131 patients)and a control group(135 patients);the clinical data of the two groups were compared.Results:After intervention,the scores of Hamilton Anxiety Scale(HAM-A)of the patients in the observation group were lower than those in the control group(P<0.05).The rate of postoperative complications in the observation group was lower than that in the control group(P<0.05),and the satisfaction degree of the patients in the observation group was higher than that in the control group(P<0.05).Conclusion:The application of the whole-course management model in endometrial polyp day surgery can alleviate patients’anxiety,ensure the quality and safety of day surgery nursing,and improve patients’satisfaction.展开更多
Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyp...Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyp</span><span style="font-size:12px;font-family:Verdana;">s and endometriosis, is quite high among general population. The presenc</span><span style="font-size:12px;font-family:Verdana;">e of </span><span style="font-size:12px;font-family:Verdana;">endometrial polyps and endometriosis could affect infertile women. We performed </span><span style="font-size:12px;font-family:Verdana;">a retrospective multicentric study, based on data collected from three </span><span style="font-size:12px;font-family:Verdana;">Hospitals (S. Antonio Abate, Trapani, Civico-Ascoli, Palermo, and Cannizzaro,</span> <span style="font-size:12px;font-family:Verdana;">Catania). We analyzed 285 women undergoing diagnostic/office hysteroscopy. Clinical history demographic and hysteroscopic data were collected in the same sheet, containing within informed consent. On the base of our results no relationship exists between endometrial polyps and endometriosis nor</span><span> </span><span style="font-size:12px;font-family:Verdana;">cervical polyps. It’s the first time that none correlation is proved for the coexisten</span><span style="font-size:12px;font-family:Verdana;">ce of endometrial polyps and endometriosis. Further research is needed.展开更多
Intention of the study: The prevalence of endometrial polyps has been demonstrated in between 10% and 35% of all women, but knowledge regarding malignant potential within polyps is limited. Even though premalignant an...Intention of the study: The prevalence of endometrial polyps has been demonstrated in between 10% and 35% of all women, but knowledge regarding malignant potential within polyps is limited. Even though premalignant and malignant changes have been reported in up to 24% of all cases, no objective tissue markers have ever been developed for routine diagnostics to select high risk cases. As vascular changes and activation of endometrial angiogenesis has been demonstrated in former studies, our main objective was to evaluate different members of the angiogenic pathway as potential risk factors for cancer development. Patients and methods: Formalin-fixed, paraffin-embedded tissue from 15 women with benign endometrial polyps, and 16 women diagnosed with endometrial cancer were included. Immunohistochemical investigation with antibodies against VEGF, VEGF-B, VEGFR2, VEGFR3, CD31, CD34, actin, and factorVIII was performed, followed by evaluation of staining intensity of microvessels, evaluation of H-score in glands (cell membrane, cytoplasm) and stroma, and measurement of micro vessel density. Results: Expression of CD31 in microvessels was significantly stronger in cancers compared to endometrial polyps (P = 0.006 for arterioles, P = 0.038, for venyles, and P = 0.002 for capillaries, respectively), whereas, a reverse change was shown for CD34. Expression of actin in capillary walls was also significantly increased in cancers compared to polyps (P = 0.002). No significant difference was found for staining intensity in microvessels (arterioles, venyles or capillaries) in endometrial benign polyps compared with endometrial cancers for VEGF, VEGFB, VEGFR2, VEGFR3, or Factor VIII. Also no difference in H-score values between benign polyps and endometrial cancers could be detected in glandular epithelium, in epithelial cell membrane or in stroma for VEGFR3, CD31 or Factor VIII. Conclusions: The present study strongly indicates that activation of angiogenesis differs in benign endometrial polyps and endometrial cancers. Thus, immunohistochemical expression of specific angiogenic markers may be of great importance as prognostic factors in the routine diagnostics of this lesion. The ratio between stromal expression of CD34 and actin might be of particular interest to select polyps with increased malignant potential.展开更多
Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identif...Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were <52 years old (p < 0.001). Among those women with dysplasia, 12/41 (29%) were p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The <52-year-old cancer patient had treatment-resistant bleeding. Increasing weight was a risk factor associated with tissue alterations in endometrial polyps (p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.展开更多
Objective:To investigate the preventive effect of Huayu Xiaozheng therapy method of traditional Chinese medicine on the recurrence of multiple endometrial polyps after hysteroscopic electro resection.Methods:A total o...Objective:To investigate the preventive effect of Huayu Xiaozheng therapy method of traditional Chinese medicine on the recurrence of multiple endometrial polyps after hysteroscopic electro resection.Methods:A total of 120 patients with blood stasis diagnosed with multiple endometrial polyps after hysteroscopic electroresection were divided into Traditional Chinese medicine group(38 people),Manyuele group(27 people),contraceptive pill group(34 people)and control group(21 people),and the endometrial thickness,polyp recurrence cases and TCM syndrome points were observed in 4 groups after treatment in 3 months,6 months and 12 months..Results:The endometrial thickness was statistically significant(P<0.05)before and after treatment in the Chinese medicine group,the Manyuele group and the contraceptive group,and the endometrial thickness was statistically significant(P<0.05)in the 1 year after treatment,and the endometrial thickness of the Chinese medicine group was compared with the contraceptive group and the Manyuele group in the 1 year after treatment,and the difference was not statistically significant.The differences in TCM symptoms in the Chinese medicine treatment group were statistically significant compared with those in the contraceptive group and the Manyuele group(P<0.05).The recurrence rate of polyps in the 1 year after treatment was statistically significant compared with the control group(P<0.05),and the difference between the three groups was not statistically significant(P>0.05).Conclusion:The traditional Chinese medicine stasis elimination method has a preventive effect on the recurrence of endometrial polyps,and its preventive effect is no different from that of Western medicine,and can significantly improve clinical symptoms.展开更多
Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic ...Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic devices.ER procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness resection.Complete resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these goals.The EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such device.The EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA clearance.This review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.展开更多
The development of receptive endometrium(RE) from pre-receptive endometrium(PE) for successful embryo implantation is a complex dynamic process in which the morphology and physiological states of the endometrial epith...The development of receptive endometrium(RE) from pre-receptive endometrium(PE) for successful embryo implantation is a complex dynamic process in which the morphology and physiological states of the endometrial epithelium undergo a series of significant changes, including cell proliferation and apoptosis. However, the molecular mechanisms are not yet fully understood. In this study, a higher circRNA3669 level was observed in PE than in RE of goats. Functional assays revealed that this overexpression promoted the proliferation of goat endometrial epithelial cells(GEECs) by activating the expression of genes related to the PI3K/AKT-mTOR and MAPK pathways,thereby inhibiting apoptosis in vitro. Furthermore, circRNA3669 functioned as a competing endogenous RNA(ceRNA) to upregulate Reticulocalbin-2(RCN2) expression at the post-transcriptional level by interacting with and downregulating miR-26a in GEECs. In addition, RCN2, which is highly expressed in the PE of goats, was found to be regulated by β-estradiol(E2) and progesterone(P4). Our results demonstrated that RCN2 also affected the key proteins PI3K, AKT, mTOR, JNK, and P38 in the PI3K/AKT-mTOR and MAPK pathways, thereby facilitating GEECs proliferation and suppressing their apoptosis in vitro. Collectively, we constructed a new circRNA3669-miR-26aRCN2 regulatory network in GEECs, which further provides strong evidence that circRNA could potentially play a crucial regulatory role in the development of RE in goats.展开更多
Background:The interrelation between intestinal polyps,metabolic syndrome(MetS),and colorectal cancer(CRC)is a critical area of study.This research focuses on pinpointing potential molecular targets to understand the ...Background:The interrelation between intestinal polyps,metabolic syndrome(MetS),and colorectal cancer(CRC)is a critical area of study.This research focuses on pinpointing potential molecular targets to understand the link between intestinal polyp formation,metabolic irregularities,and CRC progression.Methods:We examined clinical samples from patients with intestinal polyps coexisting with MetS and compared them with samples from patients with standard intestinal polyps.Transcriptome sequencing and public database analysis were employed to identify significant pathways and genes.These targets were then validated through immunohistochemistry(IHC).Following the RNA interference of key target expression,a series of experiments,including the cell counting kit-8 assay,colony formation,wound healing,and Transwell assays,were conducted.Results:Comparative analysis revealed 75 up-regulated and 61 down-regulated differentially expressed genes(DEGs)in the MetS polyp group vs.the control.Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment suggested these DEGs were primarily associated with cell cycle and mitosis.Integration with comparative toxicogenomics database(CTD)and the cancer genome atlas(TCGA)databases highlighted 44 key CRC-related genes.Protein interaction networks indicated connections of purkinje cell protein 4(PCP4),olfactomedin 1(OLFM1),fibronectin 1(FN1),and transforming growth factor beta 3(TGF-β3)with the mitogen-activated protein kinase(MAPK)pathway.Tumor correlation studies suggested higher risk associations with FN1,PCP4,and TGF-β3,while OLFM1 was identified as a lower risk gene.Immunohistochemical analysis revealed a decrease in OLFM1 in MetS-associated intestinal polyps.Upon interference with OLFM1 in polyp epithelial cells,there was a significant enhancement in cell proliferation,colony formation,and cell migration and invasion capabilities.Conclusion:Our study highlights a significant decrease in OLFM1 expression in MetS-associated intestinal polyps.And,this reduction in OLFM1 is associated with enhanced cell proliferation,colony formation,and increased cell migration and invasion capabilities.These findings underscore the reduced OLFM1 expression in MetS-associated intestinal polyps may play a crucial role in promoting tumorigenic processes in colorectal pathology.Further research on OLFM1 may provide valuable insights into understanding and targeting MetS-associated intestinal polyps.展开更多
BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the ris...BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the risk factors for post-colon polyp surgery,H.pylori infection,and its correlation with pathologic type.METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen.They were then randomly split into modeling(n=56)and model validation(n=24)sets using R.The modeling cohort was divided into an H.pylori-infected group(n=37)and an H.pylori-uninfected group(n=19).Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H.pylori infection after colon polyp surgery.A roadmap prediction model was established and validated.Finally,the correlation between the different pathological types of colon polyps and the occurrence of H.pylori infection was analyzed after colon polyp surgery.RESULTS Univariate results showed that age,body mass index(BMI),literacy,alcohol consumption,polyp pathology type,high-risk adenomas,and heavy diet were all influential factors in the development of H.pylori infection after intestinal polypectomy.Binary multifactorial logistic regression analysis showed that age,BMI,and type of polyp pathology were independent predictors of the occurrence of H.pylori infection after intestinal polypectomy.The area under the receiver operating characteristic curve was 0.969[95%confidence interval(95%CI):0.928–1.000]and 0.898(95%CI:0.773–1.000)in the modeling and validation sets,respectively.The slope of the calibration curve of the graph was close to 1,and the goodness-of-fit test was P>0.05 in the two sets.The decision analysis curve showed a high rate of return in both sets.The results of the correlation analysis between different pathological types and the occurrence of H.pylori infection after colon polyp surgery showed that hyperplastic polyps,inflammatory polyps,and the occurrence of H.pylori infection were not significantly correlated.In contrast,adenomatous polyps showed a significant positive correlation with the occurrence of H.pylori infection.CONCLUSION Age,BMI,and polyps of the adenomatous type were independent predictors of H.pylori infection after intestinal polypectomy.Moreover,the further constructed column-line graph prediction model of H.pylori infection after intestinal polypectomy showed good predictive ability.展开更多
BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses met...BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.展开更多
BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled muc...BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled mucosa)surrounding colo-rectal polyps,caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors.CSM-positive colorectal polyps are associated with various diseases;however,their prognosis varies greatly.Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps.Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.METHODS This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy.All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system.Based on the pathological results,patients were classified as non-neoplastic polyps(five juvenile polyps),neoplastic polyps,non-invasive high-grade neoplasia(NHGN),or submucosal invasive carcinoma(SM stage cancer).We analyzed and compared the clinical features,suspected risk factors for malignant transformation of neoplastic polyps,and early infiltration of sub-mucosal carcinoma.RESULTS The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps.Most NHGN polyps had a deeper red mucosal color.On logistic regression analyses,diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps.Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM;type 2 CSM was more common in neoplastic polyps.Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer.Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months.No tumor recurrence was found during either partial or complete endoscopic resection of the CSM.CONCLUSION CSM-positive colorectal polyps>1 cm in diameter or with deeper red mucosa may be related to NHGN.Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.展开更多
BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after...BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020.Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were invest-igated.Event rates for categorical variables and means for continuous variables with 95%confidence intervals were calculated,and Fisher’s exact test and Mann-Whitney test were performed.Potential risk factors of adverse outcomes were RESULTS In total,135 lesions(mean size:22.1 mm;location:42%rectal)from 129 patients(mean age:67.7 years;56%male)were enrolled.The proportion of pedunculated and non-pedunculated lesions was similar,with en bloc resection in 82%and 47%of lesions,respectively.Tumor differentiation,distance from resection margins,depth of submucosal invasion,lymphovascular invasion,and budding were reported at 89.6%,45.2%,58.5%,31.9%,and 25.2%,respectively.Residual tumor was found in 10 patients,and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection.Univariate analysis identified piecemeal resection as a risk factor for residual malignancy(odds ratio:1.74;P=0.042).At least 1 year of follow-up was available for 117 lesions from 111 patients(mean follow-up period:5.59 years).Overall,54%,30%,30%,11%,and 16%of patients presented at the 1-year,3-year,5-year,7-year,and 9-10-year surveillance examinations.Adverse outcomes occurred in 9.0%(local recurrence and dissemination in 4 patients and 9 patients,respectively),with no difference between patients undergoing secondary surgery and surveillance only.CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement.Long-term adverse outcome rates might be higher than previously reported,irrespective of whether secondary surgery was performed.展开更多
BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Poly...BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Polyps(AI4CRP)for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYE^(TM)(Fujifilm,Tokyo,Japan).CADx influence on the optical diagnosis of an expert endoscopist was also investigated.METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm.Both CADxsystems exploit convolutional neural networks.Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard.AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value(range 0.0-1.0).A predefined cut-off value of 0.6 was set with values<0.6 indicating benign and values≥0.6 indicating premalignant colorectal polyps.Low confidence characterizations were defined as values 40%around the cut-off value of 0.6(<0.36 and>0.76).Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps.Self-critical AI4CRP,excluding 14 low confidence characterizations[27.5%(14/51)],had a diagnostic accuracy of 89.2%,sensitivity of 89.7%,and specificity of 87.5%,which was higher compared to AI4CRP.CAD EYE had a 83.7%diagnostic accuracy,74.2%sensitivity,and 100.0%specificity.Diagnostic performances of the endoscopist alone(before AI)increased nonsignificantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE(AI-assisted endoscopist).Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems,except for specificity for which CAD EYE performed best.CONCLUSION Real-time use of AI4CRP was feasible.Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.展开更多
Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pat...Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pathologically, APAM consist of irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells within the stroma, and have a similar form to adenocarcinoma, adenofibroma, adenosarcoma, and carcinosarcoma. Therefore, differential diagnosis is required in many cases. APAM is pathologically classified as a benign lesion and clinically has a comparatively favorable outcome. However, treatment and follow-up observation should be performed carefully because recurrence and residual lesions occur in many patients after conservative treatment. Concomitant development of endometrial adenocarcinoma also occurs in many cases and it is difficult to differentiate this disease from APAM. Thus, diagnosis of APAM should be made carefully, particularly since the number of cases of endometrial adenocarcinoma has increased in recent years. Furthermore, APAM tends to develop during a woman’s reproductive years, and fertility sparing treatment should be considered. Here, we review the clinicopathological characteristics of APAM, including the difficulty of diagnosis as a benign or malignant uterine tumor, and we examine the relationship between APAM and endometrial cancer.展开更多
Genome duplication events,comprising whole-genome duplication and single-gene duplication,produce a complex genomic context leading to multiple levels of genetic changes.However,the characteristics of m^(6)A modificat...Genome duplication events,comprising whole-genome duplication and single-gene duplication,produce a complex genomic context leading to multiple levels of genetic changes.However,the characteristics of m^(6)A modification,the most widespread internal eukaryotic mRNA modification,in polyploid species are still poorly understood.This study revealed the characteristics of m^(6)A methylomes within the early formation and following the evolution of allopolyploid Brassica napus.We found a complex relationship between m^(6)A modification abundance and gene expression level depending on the degree of enrichment or presence/absence of m^(6)A modification.Overall,the m^(6)A genes had lower gene expression levels than the non-m^(6)A genes.Allopolyploidization may change the expression divergence of duplicated gene pairs with identical m^(6)A patterns and diverged m^(6)A patterns.Compared with duplicated genes,singletons with a higher evolutionary rate exhibited higher m^(6)A modification.Five kinds of duplicated genes exhibited distinct distributions of m^(6)A modifications in transcripts and gene expression level.In particular,tandem duplication-derived genes showed unique m^(6)A modification enrichment around the transcript start site.Active histone modifications(H3K27ac and H3K4me3)but not DNA methylation were enriched around genes of m^(6)A peaks.These findings provide a new understanding of the features of m 6A modification and gene expression regulation in allopolyploid plants with sophisticated genomic architecture.展开更多
BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment for menorrhagia.It has been covered by the national insurance in Japan since April 2012,and its demand has been increasing as the importa...BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment for menorrhagia.It has been covered by the national insurance in Japan since April 2012,and its demand has been increasing as the importance of women’s health has advanced in society.AIM To examine the efficacy of MEA as a treatment option for menorrhagia.METHODS In this study,we retrospectively analyzed 76 patients who underwent MEA between January 2016 and March 2020 in our department.MEA was performed in the lithotomy position,under general anesthesia,and with transabdominal ultrasound guidance,including the entire endometrial circumference while confirming endometrial coagulation.The Microtaze AFM-712 and the Sounding Applicator CSA-40CBL-1006200C were used for MEA,and the endometrium was ablated using a Microtaze output of 70 W and coagulation energization time of 50 s per cycle.The visual analog scale(VAS)was used to evaluate menorrhagia,menstrual pain,and treatment satisfaction.Additionally,the hemoglobin(Hb)levels before and after MEA and associated complications were investigated.RESULTS The average age of the patients was 44.8±4.0 years.While 14 patients had functional menorrhagia,62 had organic menorrhagia,of whom 14 had endometrial polyps,40 had uterine fibroids,and 8 had adenomyosis.The VAS score before MEA and 3 and 6 mo after the procedure were 10,1.3±1.3,and 1.3±1.3,respectively,for menorrhagia and 10,1.3±1.8,and 1.3±1.8,respectively,for menstrual pain,both showing improvements(P<0.001).The MEA Hb level significantly improved from 9.2±4.2 g/dL before MEA to 13.4±1.2 g/dL after MEA(P=0.003).Treatment satisfaction was high,with a VAS score of 9.6±0.7.Endometritis was observed in one patient after surgery and was treated with antibiotics.CONCLUSION MEA is a safe and effective treatment for menorrhagia.展开更多
Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed ...Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.展开更多
Hereditary polyposis syndrome can be divided into three categories:Adenomatous,serrated,and hamartomatous polyps.Hamartomatous polyps,malformations of normal tissue presenting in a disorganized manner,are characterize...Hereditary polyposis syndrome can be divided into three categories:Adenomatous,serrated,and hamartomatous polyps.Hamartomatous polyps,malformations of normal tissue presenting in a disorganized manner,are characterized by an autosomal dominant inheritance pattern.These syndromes exhibit hamartomatous gastrointestinal polyps in conjunction to extra-intestinal manifestations,which require conscientious and diligent monitoring.Peutz-Jeghers syndrome,Cowden syndrome,and juvenile polyposis syndrome are the most common displays of hamartomatous polyposis syndrome(HPS).Diagnosis can be pursued with molecular testing and endoscopic sampling.Early identification of these autosomal dominant pathologies allows to optimize malignancy surveillance,which helps reduce morbidity and mortality in both the affected patient population as well as at-risk family members.Endoscopic surveillance is an important pillar of prognosis and monitoring,with many patients eventually requiring surgical intervention.In this review,we discuss the diagnosis,surveillance,and management of HPS.展开更多
文摘BACKGROUND The procedure for microwave endometrial ablation(MEA)follows established MEA practice guidelines but requires hysteroscopic observation of the uterine lumen before and after MEA.When a luminal uterine lesion is recognized,its removal requires preoperative dilation of the cervix because the outer diameter of a conventional rigid hysteroscope is 8.7 mm.Recently,a fully disposable rigid hysteroscope(LiNA OperaScope^(TM))with a narrow diameter(4.4 mm)and forceps capable of extracting endometrial lesions has become available.CASE SUMMARY Here,we report a case of heavy menstrual bleeding(HMB)complicated by endometrial polyps where MEA was performed after removing endometrial polyps using the LiNA OperaScope^(TM) device.A 48-year-old woman with three prior pregnancies and three deliveries was referred to our hospital for further examination and treatment after being diagnosed with HMB 2 years earlier.The patient underwent MEA following endometrial polypectomy using LiNA OperaScope^(TM).After MEA,endometrial cauterization was again examined using the LiNA OperaScope^(TM),and the procedure was completed.No preoperative cervical dilation was performed.The patient’s clinical course was favorable,and she was discharged 3 h after surgery.One month after surgery,menstruation resumed,and both HMB and dysmenorrhea improved markedly from 10 preoperatively to 1 postoperatively,as assessed subjectively using the visual analog scale.The patient’s postoperative course was uneventful with no complic-ations.CONCLUSION LiNA OperaScope^(TM) can be a minimally invasive treatment for MEA of HMB with uterine lumen lesions.
文摘Objective:To explore the effect of whole-process management model in nursing management of endometrial polyp day surgery.Methods:266 patients that underwent endometrial polyp day surgery from January to December 2022 were selected for this study,and they were separated into an observation group(131 patients)and a control group(135 patients);the clinical data of the two groups were compared.Results:After intervention,the scores of Hamilton Anxiety Scale(HAM-A)of the patients in the observation group were lower than those in the control group(P<0.05).The rate of postoperative complications in the observation group was lower than that in the control group(P<0.05),and the satisfaction degree of the patients in the observation group was higher than that in the control group(P<0.05).Conclusion:The application of the whole-course management model in endometrial polyp day surgery can alleviate patients’anxiety,ensure the quality and safety of day surgery nursing,and improve patients’satisfaction.
文摘Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyp</span><span style="font-size:12px;font-family:Verdana;">s and endometriosis, is quite high among general population. The presenc</span><span style="font-size:12px;font-family:Verdana;">e of </span><span style="font-size:12px;font-family:Verdana;">endometrial polyps and endometriosis could affect infertile women. We performed </span><span style="font-size:12px;font-family:Verdana;">a retrospective multicentric study, based on data collected from three </span><span style="font-size:12px;font-family:Verdana;">Hospitals (S. Antonio Abate, Trapani, Civico-Ascoli, Palermo, and Cannizzaro,</span> <span style="font-size:12px;font-family:Verdana;">Catania). We analyzed 285 women undergoing diagnostic/office hysteroscopy. Clinical history demographic and hysteroscopic data were collected in the same sheet, containing within informed consent. On the base of our results no relationship exists between endometrial polyps and endometriosis nor</span><span> </span><span style="font-size:12px;font-family:Verdana;">cervical polyps. It’s the first time that none correlation is proved for the coexisten</span><span style="font-size:12px;font-family:Verdana;">ce of endometrial polyps and endometriosis. Further research is needed.
文摘Intention of the study: The prevalence of endometrial polyps has been demonstrated in between 10% and 35% of all women, but knowledge regarding malignant potential within polyps is limited. Even though premalignant and malignant changes have been reported in up to 24% of all cases, no objective tissue markers have ever been developed for routine diagnostics to select high risk cases. As vascular changes and activation of endometrial angiogenesis has been demonstrated in former studies, our main objective was to evaluate different members of the angiogenic pathway as potential risk factors for cancer development. Patients and methods: Formalin-fixed, paraffin-embedded tissue from 15 women with benign endometrial polyps, and 16 women diagnosed with endometrial cancer were included. Immunohistochemical investigation with antibodies against VEGF, VEGF-B, VEGFR2, VEGFR3, CD31, CD34, actin, and factorVIII was performed, followed by evaluation of staining intensity of microvessels, evaluation of H-score in glands (cell membrane, cytoplasm) and stroma, and measurement of micro vessel density. Results: Expression of CD31 in microvessels was significantly stronger in cancers compared to endometrial polyps (P = 0.006 for arterioles, P = 0.038, for venyles, and P = 0.002 for capillaries, respectively), whereas, a reverse change was shown for CD34. Expression of actin in capillary walls was also significantly increased in cancers compared to polyps (P = 0.002). No significant difference was found for staining intensity in microvessels (arterioles, venyles or capillaries) in endometrial benign polyps compared with endometrial cancers for VEGF, VEGFB, VEGFR2, VEGFR3, or Factor VIII. Also no difference in H-score values between benign polyps and endometrial cancers could be detected in glandular epithelium, in epithelial cell membrane or in stroma for VEGFR3, CD31 or Factor VIII. Conclusions: The present study strongly indicates that activation of angiogenesis differs in benign endometrial polyps and endometrial cancers. Thus, immunohistochemical expression of specific angiogenic markers may be of great importance as prognostic factors in the routine diagnostics of this lesion. The ratio between stromal expression of CD34 and actin might be of particular interest to select polyps with increased malignant potential.
文摘Objective: To illuminate the findings after hysteroscopic surgery of endometrial polyps. Method: Data were extracted from The Swedish National Quality Registry of Gynecological Surgery. Endometrial polyps were identified in 1934 cases in a total of 4512 hysteroscopic operations. Data on all hysteroscopic procedures registered as surgery of endometrial polyps between 1997 and January 2013 were analyzed with logistic regression analysis and effect size was calculated. Main outcome measure was malignancy in endometrial polyps. Results: The most frequently reported symptoms of endometrial polyps were: postmenopausal bleeding, metrorrhagia, pain, and infertility. Among the registered biopsies, there were: 30 malignancies (1.8%), and 41 dysplasias (2.5%). The remaining polyps were benign. Only 1/30 cancer patients were <52 years old (p < 0.001). Among those women with dysplasia, 12/41 (29%) were p = 0.07). All cancer patients at age ≥52 had postmenopausal bleeding. The <52-year-old cancer patient had treatment-resistant bleeding. Increasing weight was a risk factor associated with tissue alterations in endometrial polyps (p = 0.014), controlling for age as a confounding factor. Conclusion: Hysteroscopic surgery should be recommended for women with postmenopausal bleeding and presence of endometrial polyps according to the findings of this study. The results further indicate a low risk of malignancy in premenopausal women <52 years with endometrial polyps. In those cases, it seems to be safe to refrain from surgery.
文摘Objective:To investigate the preventive effect of Huayu Xiaozheng therapy method of traditional Chinese medicine on the recurrence of multiple endometrial polyps after hysteroscopic electro resection.Methods:A total of 120 patients with blood stasis diagnosed with multiple endometrial polyps after hysteroscopic electroresection were divided into Traditional Chinese medicine group(38 people),Manyuele group(27 people),contraceptive pill group(34 people)and control group(21 people),and the endometrial thickness,polyp recurrence cases and TCM syndrome points were observed in 4 groups after treatment in 3 months,6 months and 12 months..Results:The endometrial thickness was statistically significant(P<0.05)before and after treatment in the Chinese medicine group,the Manyuele group and the contraceptive group,and the endometrial thickness was statistically significant(P<0.05)in the 1 year after treatment,and the endometrial thickness of the Chinese medicine group was compared with the contraceptive group and the Manyuele group in the 1 year after treatment,and the difference was not statistically significant.The differences in TCM symptoms in the Chinese medicine treatment group were statistically significant compared with those in the contraceptive group and the Manyuele group(P<0.05).The recurrence rate of polyps in the 1 year after treatment was statistically significant compared with the control group(P<0.05),and the difference between the three groups was not statistically significant(P>0.05).Conclusion:The traditional Chinese medicine stasis elimination method has a preventive effect on the recurrence of endometrial polyps,and its preventive effect is no different from that of Western medicine,and can significantly improve clinical symptoms.
文摘Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic devices.ER procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness resection.Complete resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these goals.The EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such device.The EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA clearance.This review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.
基金supported by the China Postdoctoral Science Foundation(2019M653776 and 2020M673516)the Natural Science Basis Research Plan in Shaanxi Province of China(2023-JC-QN-0181)+1 种基金the Shaanxi Livestock and Poultry Breeding Double-chain Fusion Key Project,China(2022GD-TSLD-46-0202)the Natural Science Fundation of Tibet Autonomous Region,China(XZ202101ZR0063G)。
文摘The development of receptive endometrium(RE) from pre-receptive endometrium(PE) for successful embryo implantation is a complex dynamic process in which the morphology and physiological states of the endometrial epithelium undergo a series of significant changes, including cell proliferation and apoptosis. However, the molecular mechanisms are not yet fully understood. In this study, a higher circRNA3669 level was observed in PE than in RE of goats. Functional assays revealed that this overexpression promoted the proliferation of goat endometrial epithelial cells(GEECs) by activating the expression of genes related to the PI3K/AKT-mTOR and MAPK pathways,thereby inhibiting apoptosis in vitro. Furthermore, circRNA3669 functioned as a competing endogenous RNA(ceRNA) to upregulate Reticulocalbin-2(RCN2) expression at the post-transcriptional level by interacting with and downregulating miR-26a in GEECs. In addition, RCN2, which is highly expressed in the PE of goats, was found to be regulated by β-estradiol(E2) and progesterone(P4). Our results demonstrated that RCN2 also affected the key proteins PI3K, AKT, mTOR, JNK, and P38 in the PI3K/AKT-mTOR and MAPK pathways, thereby facilitating GEECs proliferation and suppressing their apoptosis in vitro. Collectively, we constructed a new circRNA3669-miR-26aRCN2 regulatory network in GEECs, which further provides strong evidence that circRNA could potentially play a crucial regulatory role in the development of RE in goats.
基金This work was supported by Hospital Incubation Fund of the First Affiliated Hospital of Chongqing Medical and Pharmaceutical College(No.201704).
文摘Background:The interrelation between intestinal polyps,metabolic syndrome(MetS),and colorectal cancer(CRC)is a critical area of study.This research focuses on pinpointing potential molecular targets to understand the link between intestinal polyp formation,metabolic irregularities,and CRC progression.Methods:We examined clinical samples from patients with intestinal polyps coexisting with MetS and compared them with samples from patients with standard intestinal polyps.Transcriptome sequencing and public database analysis were employed to identify significant pathways and genes.These targets were then validated through immunohistochemistry(IHC).Following the RNA interference of key target expression,a series of experiments,including the cell counting kit-8 assay,colony formation,wound healing,and Transwell assays,were conducted.Results:Comparative analysis revealed 75 up-regulated and 61 down-regulated differentially expressed genes(DEGs)in the MetS polyp group vs.the control.Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment suggested these DEGs were primarily associated with cell cycle and mitosis.Integration with comparative toxicogenomics database(CTD)and the cancer genome atlas(TCGA)databases highlighted 44 key CRC-related genes.Protein interaction networks indicated connections of purkinje cell protein 4(PCP4),olfactomedin 1(OLFM1),fibronectin 1(FN1),and transforming growth factor beta 3(TGF-β3)with the mitogen-activated protein kinase(MAPK)pathway.Tumor correlation studies suggested higher risk associations with FN1,PCP4,and TGF-β3,while OLFM1 was identified as a lower risk gene.Immunohistochemical analysis revealed a decrease in OLFM1 in MetS-associated intestinal polyps.Upon interference with OLFM1 in polyp epithelial cells,there was a significant enhancement in cell proliferation,colony formation,and cell migration and invasion capabilities.Conclusion:Our study highlights a significant decrease in OLFM1 expression in MetS-associated intestinal polyps.And,this reduction in OLFM1 is associated with enhanced cell proliferation,colony formation,and increased cell migration and invasion capabilities.These findings underscore the reduced OLFM1 expression in MetS-associated intestinal polyps may play a crucial role in promoting tumorigenic processes in colorectal pathology.Further research on OLFM1 may provide valuable insights into understanding and targeting MetS-associated intestinal polyps.
文摘BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the risk factors for post-colon polyp surgery,H.pylori infection,and its correlation with pathologic type.METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen.They were then randomly split into modeling(n=56)and model validation(n=24)sets using R.The modeling cohort was divided into an H.pylori-infected group(n=37)and an H.pylori-uninfected group(n=19).Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H.pylori infection after colon polyp surgery.A roadmap prediction model was established and validated.Finally,the correlation between the different pathological types of colon polyps and the occurrence of H.pylori infection was analyzed after colon polyp surgery.RESULTS Univariate results showed that age,body mass index(BMI),literacy,alcohol consumption,polyp pathology type,high-risk adenomas,and heavy diet were all influential factors in the development of H.pylori infection after intestinal polypectomy.Binary multifactorial logistic regression analysis showed that age,BMI,and type of polyp pathology were independent predictors of the occurrence of H.pylori infection after intestinal polypectomy.The area under the receiver operating characteristic curve was 0.969[95%confidence interval(95%CI):0.928–1.000]and 0.898(95%CI:0.773–1.000)in the modeling and validation sets,respectively.The slope of the calibration curve of the graph was close to 1,and the goodness-of-fit test was P>0.05 in the two sets.The decision analysis curve showed a high rate of return in both sets.The results of the correlation analysis between different pathological types and the occurrence of H.pylori infection after colon polyp surgery showed that hyperplastic polyps,inflammatory polyps,and the occurrence of H.pylori infection were not significantly correlated.In contrast,adenomatous polyps showed a significant positive correlation with the occurrence of H.pylori infection.CONCLUSION Age,BMI,and polyps of the adenomatous type were independent predictors of H.pylori infection after intestinal polypectomy.Moreover,the further constructed column-line graph prediction model of H.pylori infection after intestinal polypectomy showed good predictive ability.
基金Supported by Suzhou Municipal Science and Technology Program of China,No.SKJY2021012.
文摘BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.
基金the Science and Technology Plan Project of Chengdu Municipal Health Commission,No.2019007.
文摘BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled mucosa)surrounding colo-rectal polyps,caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors.CSM-positive colorectal polyps are associated with various diseases;however,their prognosis varies greatly.Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps.Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.METHODS This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy.All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system.Based on the pathological results,patients were classified as non-neoplastic polyps(five juvenile polyps),neoplastic polyps,non-invasive high-grade neoplasia(NHGN),or submucosal invasive carcinoma(SM stage cancer).We analyzed and compared the clinical features,suspected risk factors for malignant transformation of neoplastic polyps,and early infiltration of sub-mucosal carcinoma.RESULTS The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps.Most NHGN polyps had a deeper red mucosal color.On logistic regression analyses,diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps.Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM;type 2 CSM was more common in neoplastic polyps.Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer.Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal cancer disappeared within 12 months.No tumor recurrence was found during either partial or complete endoscopic resection of the CSM.CONCLUSION CSM-positive colorectal polyps>1 cm in diameter or with deeper red mucosa may be related to NHGN.Resection of CSM surrounding colorectal adenomas did not affect tumor recurrence.
基金Supported by the New National Excellence Program of the Ministry for Innovation and Technology From the Source of the National Research,Development and Innovation Fund,No.ÚNKP-22-4-SZTE-296,No.ÚNKP-23-3-SZTE-268,and No.ÚNKP-23-5-SZTE-719the EU’s Horizon 2020 Research and Innovation Program under Grant Agreement,No.739593.
文摘BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020.Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were invest-igated.Event rates for categorical variables and means for continuous variables with 95%confidence intervals were calculated,and Fisher’s exact test and Mann-Whitney test were performed.Potential risk factors of adverse outcomes were RESULTS In total,135 lesions(mean size:22.1 mm;location:42%rectal)from 129 patients(mean age:67.7 years;56%male)were enrolled.The proportion of pedunculated and non-pedunculated lesions was similar,with en bloc resection in 82%and 47%of lesions,respectively.Tumor differentiation,distance from resection margins,depth of submucosal invasion,lymphovascular invasion,and budding were reported at 89.6%,45.2%,58.5%,31.9%,and 25.2%,respectively.Residual tumor was found in 10 patients,and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection.Univariate analysis identified piecemeal resection as a risk factor for residual malignancy(odds ratio:1.74;P=0.042).At least 1 year of follow-up was available for 117 lesions from 111 patients(mean follow-up period:5.59 years).Overall,54%,30%,30%,11%,and 16%of patients presented at the 1-year,3-year,5-year,7-year,and 9-10-year surveillance examinations.Adverse outcomes occurred in 9.0%(local recurrence and dissemination in 4 patients and 9 patients,respectively),with no difference between patients undergoing secondary surgery and surveillance only.CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement.Long-term adverse outcome rates might be higher than previously reported,irrespective of whether secondary surgery was performed.
文摘BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Polyps(AI4CRP)for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYE^(TM)(Fujifilm,Tokyo,Japan).CADx influence on the optical diagnosis of an expert endoscopist was also investigated.METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm.Both CADxsystems exploit convolutional neural networks.Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard.AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value(range 0.0-1.0).A predefined cut-off value of 0.6 was set with values<0.6 indicating benign and values≥0.6 indicating premalignant colorectal polyps.Low confidence characterizations were defined as values 40%around the cut-off value of 0.6(<0.36 and>0.76).Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps.Self-critical AI4CRP,excluding 14 low confidence characterizations[27.5%(14/51)],had a diagnostic accuracy of 89.2%,sensitivity of 89.7%,and specificity of 87.5%,which was higher compared to AI4CRP.CAD EYE had a 83.7%diagnostic accuracy,74.2%sensitivity,and 100.0%specificity.Diagnostic performances of the endoscopist alone(before AI)increased nonsignificantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE(AI-assisted endoscopist).Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems,except for specificity for which CAD EYE performed best.CONCLUSION Real-time use of AI4CRP was feasible.Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.
文摘Atypical polypoid adenomyoma (APAM) is a rare polypoid tumor that generally occurs in women of reproductive age who have abnormal genital bleeding. The tumor was reported as a new disease concept by Mazur in 1981. Pathologically, APAM consist of irregularly proliferated endometrial gland cells and interlacing bundles of smooth muscle cells within the stroma, and have a similar form to adenocarcinoma, adenofibroma, adenosarcoma, and carcinosarcoma. Therefore, differential diagnosis is required in many cases. APAM is pathologically classified as a benign lesion and clinically has a comparatively favorable outcome. However, treatment and follow-up observation should be performed carefully because recurrence and residual lesions occur in many patients after conservative treatment. Concomitant development of endometrial adenocarcinoma also occurs in many cases and it is difficult to differentiate this disease from APAM. Thus, diagnosis of APAM should be made carefully, particularly since the number of cases of endometrial adenocarcinoma has increased in recent years. Furthermore, APAM tends to develop during a woman’s reproductive years, and fertility sparing treatment should be considered. Here, we review the clinicopathological characteristics of APAM, including the difficulty of diagnosis as a benign or malignant uterine tumor, and we examine the relationship between APAM and endometrial cancer.
基金This work was supported by the National Natural Science Foundation of China(31970241).
文摘Genome duplication events,comprising whole-genome duplication and single-gene duplication,produce a complex genomic context leading to multiple levels of genetic changes.However,the characteristics of m^(6)A modification,the most widespread internal eukaryotic mRNA modification,in polyploid species are still poorly understood.This study revealed the characteristics of m^(6)A methylomes within the early formation and following the evolution of allopolyploid Brassica napus.We found a complex relationship between m^(6)A modification abundance and gene expression level depending on the degree of enrichment or presence/absence of m^(6)A modification.Overall,the m^(6)A genes had lower gene expression levels than the non-m^(6)A genes.Allopolyploidization may change the expression divergence of duplicated gene pairs with identical m^(6)A patterns and diverged m^(6)A patterns.Compared with duplicated genes,singletons with a higher evolutionary rate exhibited higher m^(6)A modification.Five kinds of duplicated genes exhibited distinct distributions of m^(6)A modifications in transcripts and gene expression level.In particular,tandem duplication-derived genes showed unique m^(6)A modification enrichment around the transcript start site.Active histone modifications(H3K27ac and H3K4me3)but not DNA methylation were enriched around genes of m^(6)A peaks.These findings provide a new understanding of the features of m 6A modification and gene expression regulation in allopolyploid plants with sophisticated genomic architecture.
文摘BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment for menorrhagia.It has been covered by the national insurance in Japan since April 2012,and its demand has been increasing as the importance of women’s health has advanced in society.AIM To examine the efficacy of MEA as a treatment option for menorrhagia.METHODS In this study,we retrospectively analyzed 76 patients who underwent MEA between January 2016 and March 2020 in our department.MEA was performed in the lithotomy position,under general anesthesia,and with transabdominal ultrasound guidance,including the entire endometrial circumference while confirming endometrial coagulation.The Microtaze AFM-712 and the Sounding Applicator CSA-40CBL-1006200C were used for MEA,and the endometrium was ablated using a Microtaze output of 70 W and coagulation energization time of 50 s per cycle.The visual analog scale(VAS)was used to evaluate menorrhagia,menstrual pain,and treatment satisfaction.Additionally,the hemoglobin(Hb)levels before and after MEA and associated complications were investigated.RESULTS The average age of the patients was 44.8±4.0 years.While 14 patients had functional menorrhagia,62 had organic menorrhagia,of whom 14 had endometrial polyps,40 had uterine fibroids,and 8 had adenomyosis.The VAS score before MEA and 3 and 6 mo after the procedure were 10,1.3±1.3,and 1.3±1.3,respectively,for menorrhagia and 10,1.3±1.8,and 1.3±1.8,respectively,for menstrual pain,both showing improvements(P<0.001).The MEA Hb level significantly improved from 9.2±4.2 g/dL before MEA to 13.4±1.2 g/dL after MEA(P=0.003).Treatment satisfaction was high,with a VAS score of 9.6±0.7.Endometritis was observed in one patient after surgery and was treated with antibiotics.CONCLUSION MEA is a safe and effective treatment for menorrhagia.
基金supported by grants from the National Natural Science Foundation of China(No.81873694)the Key Research and Development Program of Hubei Province(No.2021BCA119 and No.2022BCA005)Knowledge Innovation Program of Wuhan-Basic Research(No.2022020801010446).
文摘Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.
文摘Hereditary polyposis syndrome can be divided into three categories:Adenomatous,serrated,and hamartomatous polyps.Hamartomatous polyps,malformations of normal tissue presenting in a disorganized manner,are characterized by an autosomal dominant inheritance pattern.These syndromes exhibit hamartomatous gastrointestinal polyps in conjunction to extra-intestinal manifestations,which require conscientious and diligent monitoring.Peutz-Jeghers syndrome,Cowden syndrome,and juvenile polyposis syndrome are the most common displays of hamartomatous polyposis syndrome(HPS).Diagnosis can be pursued with molecular testing and endoscopic sampling.Early identification of these autosomal dominant pathologies allows to optimize malignancy surveillance,which helps reduce morbidity and mortality in both the affected patient population as well as at-risk family members.Endoscopic surveillance is an important pillar of prognosis and monitoring,with many patients eventually requiring surgical intervention.In this review,we discuss the diagnosis,surveillance,and management of HPS.
