Objective

To assess the feasibility and efficacy of peroral transpapillary ultrasonic lithotripsy and litholysis with D-limonene for gallbladder-preserving gallstone removal in vitro experiment.

Methods

Between October 15,2024,and April 1,2025,72 fresh gallstones (24 cholesterol,24 pigment,24 mixed) were collected after cholecystectomy at the First Medical Center of Chinese PLA General Hospital and classified by infrared spectroscopy. Each stone type was randomly divided into D-limonene dissolution alone group (D-limonene group) or the other group combined with D-limonene dissolution and ultrasonic lithotripsy (hybrid group). There was no significant difference in the weight and size of the stones between the two groups. The D-limonene group received 20 mL of D-limonene at 37℃ with 60 rpm stirring for 8 hours, while the hybrid group received additional 1 MHz ultrasonic intervention. Dissolution time andefficiency were compared between the two groups. For stone types that could achieve complete dissolution, dissolution time was compared; for those that could not, dissolution rate was compared.Dissolution rate was defined as: (pre-procedure gallstone weight -post-procedure gallstone weight)/preprocedure gallstone weight.

Results

For cholesterol stones and mixed stones, the complete dissolution time in hybrid group were much shorter than those in D-limonene group (36. 42 ± 18. 05 vs. 130. 83 ±51.60 min,93.75 ±26.38 vs. 353.33 ±120.70 min, respectively, all P <0.001). For pigment stones,5 stones (41. 6%) in hybrid group achieved complete dissolution within 8 hours, while no stones in D-limonene group did. Based on the weight of residual stones, the median dissolution rate in hybrid group was much higher (72.46% vs. 16.70%, P <0.001).

Conclusion

Our in vitro experiment preliminarily showed that peroral transpapillary ultrasnonic lithotripsy and litholysis with D-limonene is feasible, and more efficient compared with D-limonene dissolution alone. With the spread of super minimally invasive surgery,it may provide a viable and promising therapeutic alternative for gallstone for gallbladder-preserving gallstone removal.

Objective

This article aims to explore the selection and efficacy of endoscopic treatment strategies based on gastric SMT growth pattern.

Methods

A retrospective collection was conducted on 143 patients with gastric SMT who were hospitalized at the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Chinese Medicine from January 2014 to August 2024. Their growth patterns were determined based on endoscopic ultrasound (EUS) or CT scans,and the selection of endoscopic treatment strategies,effects,and complications were analyzed.

Results

Among 143 patients, 63 were in the endoluminal group,50 in the intramural group and 30 in the extraluminal group; There were 58 males and 85 females with an average age of (57.84 ±11.99) years. There was no significant difference in age, sex, growth site, tumor diameter, operation time, endoscopic complete resection rate and pathological type among the three groups(P>0.05). The EFR rate, purse string suture rate and gastric tube indwelling rate in the extraluminal group and intramural group were significantly higher than those in the luminal group (P< 0.001,0.002, <0.001). Further multivariate regression analysis showed that only the surgical methods between these groups were still statistically different (P=0.011), but the wound suture method and gastric tube indwelling rate were not statistically significant (P=0.159,0.131). Subgroup analysis showed that the EFR rate of lesions located in the fundus of stomach was significantly higher than that of non-fundus of stomach (P =0.049,0.021). Further multivariate analysis showed that the EFR rate of lesions located in the fundus of stomach was significantly higher than that of non-fundus of stomach in the intramural group only (P =0. 003).

Conclusion

Endoscopic treatment of gastric SMT is safe and effective. ESE treatment is mainly used for intracavitary and intramural SMT in non gastric fundus areas, while EFR treatment is required for intramural SMT in gastric fundus areas and all extraluminal SMT. The growth pattern of gastric SMT has guiding significance for the selection of endoscopic treatment strategies, which is helpful for preoperative preparation and perioperative management.

Objective

To evaluate the impact of super minimally invasive surgery (SMIS) on the human body by comparing inflammatory factors between gastric cancer patients undergoing SMIS and organ resection surgery (ORS).

Methods

A prospective randomized study included 20 gastric cancer patients who underwent SMIS in the of Department of Gastroenterology from May 2023 to April 2024, and 20 gastric cancer patients who underwent ORS in the General Surgery Department of PLA General Hospital. Enzymelinked immunosorbent assay was used to detect changes in the concentrations of six inflammatory factorstumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-1 beta (IL-1β), interleukin-4(IL-4),interleukin-10 (IL-10),and transforming growth factor-beta (TGF-β)-in serum samples collected 1 day before surgery and 3 days after surgery.

Results

There were no statistically significant differences in the concentrations of the six inflammatory factors before and after SMIS (P > 0.05), nor were there significant differences before and after ORS (P > 0. 05).

Conclusion

In terms of controlling early postoperative inflammatory responses, SMIS shows comparable performance to ORS. Future studies may extend the observation time window or incorporate more inflammatory indicators to comprehensively evaluate the effects of different surgical procedures on traumatic inflammatory responses.

Objective

This study aims to investigate the endoscopic, clinicopathological features,treatment and prognosis of fundic gland type neoplasms.

Methods

A retrospective analysis was conducted on 17 patients diagnosed with fundic gland type neoplasms from January 2021 to August 2024 at the Department of Pathology, First Medical Center of the PLA General Hospital. The clinical information,endoscopic findings, pathological data were collected and analyzed in conjunction with relevant literature.

Results

Among these cases, there were 12 cases of oxyntic gland adenoma (OGA), 3 cases of gastric adenocarcinoma of the fundic gland type (GA-FG), and 2 cases of gastiric adenocarcinoma of fundic gland mucosa type (GA-FGM). There were 12 males and 5 females with a median age of 58 years. The endoscopic tumors were classified as type 0-I (6 cases),type 0-Ⅱa (7 cases),type 0-Ⅱb (2 cases),and type 0-Ⅱa+Ⅱc (2 cases). Histologically, the tumor exhibited differentiation towards gastric fundus glands with evident structural atypia including dense glands with irregular shapes and partial fusion. Small cell atypia was observed predominantly along with main cell differentiation. Immunohistochemical staining showed that fundic gland type neoplasms expressed pepsinogen 1, MUC6. OGA and GA-FG were negative for MUC5AC, Ki-67 proliferation index was low, GA-FGM expressed MUC5AC in different degrees, Ki-67 proliferation index was high.

Conclusion

Fundic gland type neoplasms are rare neoplasms originating from the same lineage that exhibit variable degrees of invasiveness but generally have an indolent course. They possess distinct endoscopic manifestations and clinicopathological features requiring due attention in the routine pathological diagnosis.

Objective

To investigate the pathogenesis of chronic pancreatitis (CP), validate the relationship between CP, gut microbiota,and immune-inflammatory factors,and provide more comprehensive data support for the study of CP etiology.

Methods

Part 1:Patients admitted to the Second Affiliated Hospital of Baotou Medical College from January 2023 to December 2024 were recruited and divided into an experimental group (CP patients) and a control group (healthy individuals) based on predefined criteria.Fecal samples were collected for 16S rRNA sequencing, and serum levels of inflammatory factors, including IL-6,IL-8,IL-1β, tumor necrosis factor-α (TNF-α),and nuclear factor-κB p65 (NF-κB p65), were measured using ELISA. Differences in gut microbiota and inflammatory factors between CP patients and healthy controls were analyzed. Part 2: A dibutyltin dichloride (DBTC)-induced CP rat model was established, with rats divided into an experimental group (CP model) and a control group (blank control).DBTC was administered at high (1.6 mg·kg ^-1) and low (0.8 mg·kg ^-1) concentrations, respectively.Fecal and blood samples were collected for testing.

Results

Significant differences in gut microbiota were observed between CP patients and healthy controls, characterized by a decrease in beneficial bacteria and an increase in pathogenic bacteria.Serum levels of IL-6 (P <0.05), IL-8 (P <0.01),IL-1β (P <0.001),and NF-κB p65 (P <0.01) were higher in the CP group than in the control group,whereas TNF-α (P <0.001) was higher in the control group. Similarly,fecal test results in the CP rat model were consistent with human findings, and blood levels of NF-κB p65,IL-1β,IL-8,and TNF-α were significantly higher in the experimental group than in the control group (P <0.0001),with IL-6 (P <0.01) also elevated.

Conclusion

The study demonstrates that chronic pancreatitis is associated with gut microbiota dysbiosis and elevated immune-inflammatory factors. Furthermore,it proposes the hypothesis that gut microbiota regulates CP through the IL-1β/NF-κB p65 signaling pathway. Additionally,the high-dose DBTC-induced CP rat model was found to be more stable,providing a basis for future research.

Objective

To explore the effect of predictive nursing intervention on the clinical rehabilitation of patients with lipogenic pancreatitis.

Methods

A fixed-point continuous sampling method was used to screen 40 patients with lipogenic pancreatitis admitted to the Department of Gastroenterology,First Medical Center of PLA General Hospital from May 1, 2023, to October 31, 2023, according to inclusion and exclusion criteria. The patients were divided into a control group (routine nursing) and an intervention group (routine nursing + predictive nursing intervention) by a random number table method.The disease rehabilitation status, complication incidence, nursing satisfaction, and quality of life scores were compared between the two groups.

Results

The disease rehabilitation speed, nursing satisfaction scores,and quality of life scores of the intervention group were significantly higher than those of the control group(P <0. 05),and the complication incidence was significantly lower than that of the control group (P <0.05),with statistically significant differences.

Conclusion

Predictive nursing intervention can effectively promote the rehabilitation of patients with lipogenic pancreatitis,improve nursing satisfaction and quality of life,and reduce the incidence of complications, showing high clinical application value.

Colorectal cancer (CRC) ranks as the third most prevalent malignant tumor globally and remains a leading cause of cancer-associated mortality.Recent advances in precision medicine have opened new avenues for personalized CRC treatment,with patient-derived organoid models emerging as a transformative tool in this endeavor.Colonoscopic biopsy,now a standard diagnostic and monitoring tool for CRC,provides essential tumor tissue samples for organoid construction. These specimens are particularly valuable for predicting treatment efficacy and investigating the mechanisms of chemotherapy,targeted therapy,and immunotherapy.By establishing CRC organoid models from colonoscopic biopsies,researchers can preserve patients′ genetic and phenotypic characteristics while enabling drug sensitivity testing,biomarker screening,and investigations into drug resistance mechanisms. This review summarizes standardized protocols,key technical advantages,and recent advances in CRC organoid construction using colonoscopy-derived tissues,aiming to support the development of precise and individualized therapeutic strategies for CRC.

Gastroscopy is an important method for the diagnosis and treatment of early upper gastrointestinal cancer. Good mucosal cleaning preparation before gastroscopy can provide a clear field of vision for the examination and shorten the examination time,etc. This article reviews the role of commonly used antifoaming agents and mucus-removing agents before gastroscopy,combined medication, nursing measures, and adverse reactions.

Objective

This experiment aimed to explore the therapeutic effect of ultrasound microbubble-assisted intrarenal delivery of mesenchymal stem cell-derived exosomes under ultrasound guidance on acute kidney injury in rats.

Methods

Twenty-four male 8-week-old normal SD rats were randomly divided into four groups， with six rats in each group： the control group （normal rats injected with phosphate-buffered saline）， the model group （acute kidney injury rats injected with phosphate-buffered saline）， the exosome group （acute kidney injury rats injected with exosomes）， and the mixed vesicle group（acute kidney injury rats injected with ultrasound microbubble-mixed exosomes）.The rat model of acute kidney injury was established by intravenous injection of cisplatin （5 mg/kg） via the tail vein， while the control group rats received an equal volume of phosphate-buffered saline via the tail vein.On the first day after the establishment of the acute kidney injury model， percutaneous intrarenal injection was performed under ultrasound guidance in each group.A total of 100 μl liquid was injected into the upper and lower poles of the rat kidneys： the control group and the model group being injected with phosphate-buffered saline， while the exosome group was injected with exosomes，and the mixed vesicle group was injected with exosomes mixed with ultrasound microbubbles.Immediately after the above injections， ultrasound was applied with the same parameters for activation.The renal function of each group of rats was monitored daily after the injections，and tissue samples were collected on the 4th day.Kidney tissue pathology was observed， and the number of apoptotic cells as well as the expression of kidney injury molecule-1 （KIM-1） protein were detected.

Results

The ultrasound echogenic imaging effect of the mixed vesicle group was better than that of the exosome group.Moreover， the number of exosomes retained in the kidneys and the number of exosomes in the renal cells were both significantly increased in the mixed vesicle group compared to the exosome group （all P ＜0.05）.The renal function， renal tubular pathological injury score， number of apoptotic cells， and expression of KIM-1 protein in both the exosome group and the mixed vesicle group were better than those in the model group （all P ＜0.05）， and these parameters of the mixed vesicle group were also better than those of the exosome group（P ＜0.05）.

Conclusion

Ultrasound microbubble-assisted intrarenal delivery of mesenchymal stem cellderived exosomes under ultrasound guidance could alleviate acute kidney injury in the rats.

Objective

To investigate the association of monocyte/high-density lipoprotein cholesterol ratio （MHR） and platelet/high-density lipoprotein cholesterol ratio （PHR） with the risk of acute ischemic stroke （AIS） in maintenance hemodialysis patients.

Methods

A retrospective analysis was conducted on patients who underwent maintenance hemodialysis at Beijing Chao-Yang Hospital from January 1，2015 to June 30， 2023， and the patients were divided into the AIS group and the non-AIS group.The univariate and multivariate Cox regression models were used to analyze the predictive value of MHR and PHR for stroke risk in the patients.

Results

A total of 258 maintenance hemodialysis patients were included，with 67 patients in the AIS group and 191 patients in the non-AIS group.The median follow-up time was 63 months.There were significant differences between the AIS group and the non-AIS group in age，hypertension history， diabetes history， smoking history， MHR， and PHR （P ＜0.05）.The univariate Cox regression model analysis showed that the patients with high MHR （HR=7.439， P=0.001） and high PHR（HR=1.006， P ＜0.001） had a high risk of ischemic stroke.After adjusting for confounding factors， high MHR （HR=7.277， P=0.004） and high PHR （HR =1.007， P ＜0.001） remained the independent risk factors for AIS in the maintenance hemodialysis patients.

Conclusion

MHR and PHR were the independent risk factors for the AIS in the maintenance hemodialysis patients， and might have certain predictive value.

Objective

To explore the weight changes and their influencing factors in patients undergoing hemodialysis via different vascular accesses.

Methods

A retrospective analysis was conducted on the patients who received hemodialysis treatment in our hospital from January 2023 to December 2023.The patients were divided into the arteriovenous fistula group and the central venous catheter group according to the vascular access.The interdialytic weight gain （IDWG） of the patients in the two groups was compared.Then， the patients were again divided into the excessive IDWG group and the normal IDWG group.The differences among the groups were compared， and the influencing factors of IDWG in the patients were analyzed by the multivariate logistic regression method.

Results

A total of 238 patients undergoing hemodialysis were included， among which there were 211 patients in the arteriovenous fistula group and 27 patients in the central venous catheter group.There were 81 patients in the excessive IDWG group and 157 patients in the normal IDWG group.In the arteriovenous fistula group，68 patients had excessive IDWG and 143 patients had normal IDWG， while in the central venous catheter group，13 patients had excessive IDWG and 14 patients had normal IDWG.The average age， albumin level， and hemoglobin level of the excessive IDWG group were all lower than those of the normal IDWG group （all P ＜0.05）， while their average dialysis vintage， urea clearance index， serum phosphorus level， and C-reactive protein level were all higher than those of the normal IDWG group （all P ＜0.05）.The multivariate logistic regression analysis results showed that among all the patients， age， dialysis vintage， urea clearance index， serum phosphorus level，and C-reactive protein level were the influencing factors for IDWG.Among the patients in the arteriovenous fistula group， age， dialysis vintage， urea clearance index， albumin level， serum phosphorus level， and Creactive protein level were the influencing factors for IDWG， while among the patients in the central venous catheter group，age，dialysis vintage，albumin level，and serum phosphorus level were the influencing factors for IDWG （all P ＜0.05）.

Conclusion

There was no significant difference in the IDWG among patients undergoing hemodialysis via different vascular accesses.Age， dialysis vintage， basic nutritional level， and inflammatory level were closely related to the IDWG of the patients.

Objective

To investigate the relationship between the systemic immune-inflammation index （SII） and the risk of acute coronary syndrome （ACS） in maintenance hemodialysis patients.

Methods

A retrospective analysis was conducted on patients who underwent maintenance hemodialysis at Beijing Chao-Yang Hospital from January 1，2015 to January 1，2024.They were divided into an ACS group and a non-ACS group.Multivariate logistic regression analysis， receiver operating characteristic （ROC） curve， and the area under the curve were used to explore the relationship between SII and the risk of ACS.

Results

A total of 314 patients with a mean age of 59.31 ±12.82 years were included，among whom 171 patients were males（54.5%） and 143 patients females （45.5%）.There were 70 cases （22.3%） in the ACS group and 244 cases （77.7%） in the non-ACS group.Significant differences were found between the two groups in smoking history， diabetes history， blood pressure， parathyroid hormone， and SII （P ＜0.05）.After adjusting for confounding factors，the multivariate logistic regression analysis showed that SII was significantly associated with ACS in the patients （OR=1.002， 95%CI： 1.001-1.003，P ＜0.001）.Besides， the area under the ROC curve of SII in predicting ACS was 0.783 （95% CI： 0. 723-0. 843， P ＜0.001）.

Conclusion

There was a correlation between SII and ACS in the maintenance hemodialysis patients，suggesting that SII might have certain predictive value.