BACKGROUND Fecal microbiota transplantation(FMT)is a promising therapeutic approach for treating Crohn’s disease(CD).The new method of FMT,based on the automatic washing process,was named as washed microbiota transpl...BACKGROUND Fecal microbiota transplantation(FMT)is a promising therapeutic approach for treating Crohn’s disease(CD).The new method of FMT,based on the automatic washing process,was named as washed microbiota transplantation(WMT).Most existing studies have focused on observing the clinical phenomena.However,the mechanism of action of FMT for the effective management of CD-particularly in-depth multi-omics analysis involving the metagenome,metatranscriptome,and metabolome-has not yet been reported.AIM To assess the efficacy of WMT for CD and explore alterations in the microbiome and metabolome in response to WMT.METHODS We conducted a prospective,open-label,single-center clinical study.Eleven CD patients underwent WMT.Their clinical responses(defined as a decrease in their CD Activity Index score of>100 points)and their microbiome(metagenome,metatranscriptome)and metabolome profiles were evaluated three months after the procedure.RESULTS Seven of the 11 patients(63.6%)showed an optimal clinical response three months post-WMT.Gut microbiome diversity significantly increased after WMT,consistent with improved clinical symptoms.Comparison of the metagenome and metatranscriptome analyses revealed consistent alterations in certain strains,such as Faecalibac-terium prausnitzii,Roseburia intestinalis,and Escherichia coli.In addition,metabolomics analyses demonstrated that CD patients had elevated levels of various amino acids before treatment compared to the donors.However,levels of vital amino acids that may be associated with disease progression(e.g.,L-glutamic acid,gamma-glutamyl-leucine,and prolyl-glutamine)were reduced after WMT.CONCLUSION WMT demonstrated therapeutic efficacy in CD treatment,likely due to the effective reconstruction of the patient’s microbiome.Multi-omics techniques can effectively help decipher the potential mechanisms of WMT in treating CD.展开更多
BACKGROUND Guidewire slippage into the peritoneal cavity during clinical operations is extremely rare.Therefore,this paper aims to report a successful case of guidewire removal using transgastric natural orifice trans...BACKGROUND Guidewire slippage into the peritoneal cavity during clinical operations is extremely rare.Therefore,this paper aims to report a successful case of guidewire removal using transgastric natural orifice transluminal endoscopic surgery(NOTES).The goal is to enhance physicians'understanding of the management plan for this unique scenario and provide a valuable reference for clinical practice.CASE SUMMARY A 64-year-old man presented with abdominal distension and was diagnosed with cirrhosis combined with massive ascites.To proceed with treatment,the patient underwent ultrasound-guided peritoneal puncture and underwent catheterization and drainage.Unfortunately,a 0.035-inch guidewire slipped into the abdominal cavity during the procedure.Following a comprehensive evaluation and consultation by a multidisciplinary team,the guidewire was successfully removed using NOTES.CONCLUSION This case highlights the potential consideration of transgastric NOTES removal when encountering a foreign body,such as a guidewire,within the abdominal cavity.展开更多
BACKGROUND The incidence of colorectal cancer(CRC)in China is steadily rising,with a high proportion of advanced-stage diagnoses.This highlights the significance of early detection and prevention measures to enhance s...BACKGROUND The incidence of colorectal cancer(CRC)in China is steadily rising,with a high proportion of advanced-stage diagnoses.This highlights the significance of early detection and prevention measures to enhance survival rates.Fecal immunochemical testing(FIT)is a globally recommended CRC screening method;however,limited research has been conducted on its application in Hainan.AIM To assess the efficacy and adherence of FIT screening among average-risk individuals in Hainan,while also examining the risk factors associated with positive FIT results.METHODS This population-based cross-sectional study implemented FIT screening for CRC in 2000 asymptomatic participants aged 40-75 years from five cities and 21 community health centers in Hainan Province.The study was conducted from August 2022 to April 2023,employing a stratified sampling method to select participants.Individuals with positive FIT results subsequently underwent colonoscopy.Positive predictive values for confirmed CRC and advanced adenoma were calculated,and the relationship between relevant variables and positive FIT results was analyzed usingχ2 tests and multivariate logistic regression.RESULTS A total of 1788 participants completed the FIT screening,with a median age of 57 years(interquartile range:40-75).Among them,503(28.1%)were males,and 1285(71.9%)were females,resulting in an 89.4%compliance rate for FIT screening.The overall positivity rate of FIT was 4.4%[79 out of 1788;95%confidence interval(CI):3%-5%].The specific positivity rates for Haikou,Sanya,Orient City,Qionghai City,and Wuzhishan City were 9.6%(45 of 468;95%CI:8%-11%),1.3%(6 of 445;95%CI:0.1%-3.1%),2.7%(8 of 293;95%CI:1.2%-4.3%),3.3%(9 of 276;95%CI:1.0%-6.3%),and 4.2%(11 of 406;95%CI:1.2%-7.3%),respectively.Significant associations were found between age,dietary habits,and positive FIT results.Out of the 79 participants with positive FIT results,55 underwent colonoscopy,demonstrating an 82.2%compliance rate.Among them,10 had a clean gastrointestinal tract,43 had polyps or adenomas,and 2 were confirmed to have CRC,yielding a positive predictive value of 3.6%(95%CI:0.9%-4.2%).Among the 43 participants with polyps or adenomas,8 were diagnosed with advanced adenomas,resulting in an advanced adenoma rate of 14.5%(95%CI:10.1%-17.7%).CONCLUSION In the Hainan region,FIT screening for CRC among asymptomatic individuals at average risk is feasible and wellreceived.展开更多
BACKGROUND It has been confirmed that three-dimensional(3D)imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography(ERCP),which reduces th...BACKGROUND It has been confirmed that three-dimensional(3D)imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography(ERCP),which reduces the radiation dose and procedure time with improved safety.However,current 3D biliary imaging does not have good real-time fusion with intraoperative imaging,a process meant to overcome the influence of intraoperative respiratory motion and guide navigation.The present study explored the feasibility of real-time continuous image-guided ERCP.AIM To explore the feasibility of real-time continuous image-guided ERCP.METHODS We selected 23D-printed abdominal biliary tract models with different structures to simulate different patients.The ERCP environment was simulated for the biliary phantom experiment to create a navigation system,which was further tested in patients.In addition,based on the estimation of the patient’s respiratory motion,preoperative 3D biliary imaging from computed tomography of 18 patients with cholelithiasis was registered and fused in real-time with 2D fluoroscopic sequence generated by the C-arm unit during ERCP.RESULTS Continuous image-guided ERCP was applied in the biliary phantom with a registration error of 0.46 mm±0.13 mm and a tracking error of 0.64 mm±0.24mm.After estimating the respiratory motion,3D/2D registration accurately transformed preoperative 3D biliary images to each image in the X-ray image sequence in real-time in 18 patients,with an average fusion rate of 88%.CONCLUSION Continuous image-guided ERCP may be an effective approach to assist the operator and reduce the use of X-ray and contrast agents.展开更多
BACKGROUND The immune microenvironment(IME)in hepatocellular carcinoma(HCC)plays a pivotal role in determining patient outcomes and responses to treatment.This area is witnessing rapid growth in research interest.Howe...BACKGROUND The immune microenvironment(IME)in hepatocellular carcinoma(HCC)plays a pivotal role in determining patient outcomes and responses to treatment.This area is witnessing rapid growth in research interest.However,there is a lack of comprehensive bibliometric analyses that dissect trends and potential focal points in this field.AIM To explore the evolution of research on the IME in HCC from January 1,2004,to December 31,2023,using bibliometric methodologies.METHODS English articles and reviews concerning the IME of HCC were retrieved from the Web of Science Core Collection with a search date of December 31,2023.The R package Bibliometrix was employed to compute basic bibliometric characteristics,illustrate collaborations among countries and authors,and create a three-field diagram illustrating the connections between authors,affiliations,and keywords.Analyses of country and institutional co-authorship,as well as keyword co-occurrence,were conducted using VOSviewer.Additionally,CiteSpace was utilized for the cite burst analysis of keywords and cited literature.RESULTS The study encompassed 3125 documents in the research areas related to HCC of IME,revealing a substantial and continuous increase in the annual publication trend over time.China and Hehai University emerged as leading contributors,with 2103 and 165 publications,respectively.Frontiers in immunology was the most prolific journal in this domain.Among the top ten researchers in the field,eight are based in China.Key research terms identified include tumour microenvironment,expression,immunotherapy,and prognosis.CONCLUSION The relationship between HCC and IME is receiving increasing attention,and related research is in a highly developed stage.Key focus areas,including IME and immune checkpoint inhibitors,immunotherapy are poised to be central to future research endeavors,offering promising pathways for further exploration.展开更多
基金Supported by the Innovation Platform for Academicians of Hainan Province,No.YSPTZX202313Hainan Province Clinical Medical Center,No.2021818+3 种基金Hainan Provincial Health Industry Research Project,No.22A200078Hainan Provincial Postgraduate Innovation Research Project,No.Qhyb2022-133Hainan Medical University Graduate Student Innovative Research Project,No.HYYB2022A18Nanjing Medical University Fan Daiming Research Funds for Holistic Integrative Medicine,No.2020-3HIM.
文摘BACKGROUND Fecal microbiota transplantation(FMT)is a promising therapeutic approach for treating Crohn’s disease(CD).The new method of FMT,based on the automatic washing process,was named as washed microbiota transplantation(WMT).Most existing studies have focused on observing the clinical phenomena.However,the mechanism of action of FMT for the effective management of CD-particularly in-depth multi-omics analysis involving the metagenome,metatranscriptome,and metabolome-has not yet been reported.AIM To assess the efficacy of WMT for CD and explore alterations in the microbiome and metabolome in response to WMT.METHODS We conducted a prospective,open-label,single-center clinical study.Eleven CD patients underwent WMT.Their clinical responses(defined as a decrease in their CD Activity Index score of>100 points)and their microbiome(metagenome,metatranscriptome)and metabolome profiles were evaluated three months after the procedure.RESULTS Seven of the 11 patients(63.6%)showed an optimal clinical response three months post-WMT.Gut microbiome diversity significantly increased after WMT,consistent with improved clinical symptoms.Comparison of the metagenome and metatranscriptome analyses revealed consistent alterations in certain strains,such as Faecalibac-terium prausnitzii,Roseburia intestinalis,and Escherichia coli.In addition,metabolomics analyses demonstrated that CD patients had elevated levels of various amino acids before treatment compared to the donors.However,levels of vital amino acids that may be associated with disease progression(e.g.,L-glutamic acid,gamma-glutamyl-leucine,and prolyl-glutamine)were reduced after WMT.CONCLUSION WMT demonstrated therapeutic efficacy in CD treatment,likely due to the effective reconstruction of the patient’s microbiome.Multi-omics techniques can effectively help decipher the potential mechanisms of WMT in treating CD.
基金Supported by the Specific Research Fund of The Innovation Platform for Academicians of Hainan Province,No.YSPTZX202313Hainan Province Clinical Medical Center,No.2021818+1 种基金Hainan Provincial Health Industry Research Project,No.22A200078and Hainan Provincial Postgraduate Innovation Research Project,No.Qhyb2022-133.
文摘BACKGROUND Guidewire slippage into the peritoneal cavity during clinical operations is extremely rare.Therefore,this paper aims to report a successful case of guidewire removal using transgastric natural orifice transluminal endoscopic surgery(NOTES).The goal is to enhance physicians'understanding of the management plan for this unique scenario and provide a valuable reference for clinical practice.CASE SUMMARY A 64-year-old man presented with abdominal distension and was diagnosed with cirrhosis combined with massive ascites.To proceed with treatment,the patient underwent ultrasound-guided peritoneal puncture and underwent catheterization and drainage.Unfortunately,a 0.035-inch guidewire slipped into the abdominal cavity during the procedure.Following a comprehensive evaluation and consultation by a multidisciplinary team,the guidewire was successfully removed using NOTES.CONCLUSION This case highlights the potential consideration of transgastric NOTES removal when encountering a foreign body,such as a guidewire,within the abdominal cavity.
基金Supported by the Innovation Platform for Academicians of Hainan Province,No.2022136the Specific Research Fund of the Innovation Platform for Academicians of Hainan Province,No.YSPTZX202313+2 种基金Hainan Province Clinical Medical Center,No.2021818Hainan Provincial Health Industry Research Project,No.22A200078National Clinical Key Specialty Capacity Building Project,China,No.202330.
文摘BACKGROUND The incidence of colorectal cancer(CRC)in China is steadily rising,with a high proportion of advanced-stage diagnoses.This highlights the significance of early detection and prevention measures to enhance survival rates.Fecal immunochemical testing(FIT)is a globally recommended CRC screening method;however,limited research has been conducted on its application in Hainan.AIM To assess the efficacy and adherence of FIT screening among average-risk individuals in Hainan,while also examining the risk factors associated with positive FIT results.METHODS This population-based cross-sectional study implemented FIT screening for CRC in 2000 asymptomatic participants aged 40-75 years from five cities and 21 community health centers in Hainan Province.The study was conducted from August 2022 to April 2023,employing a stratified sampling method to select participants.Individuals with positive FIT results subsequently underwent colonoscopy.Positive predictive values for confirmed CRC and advanced adenoma were calculated,and the relationship between relevant variables and positive FIT results was analyzed usingχ2 tests and multivariate logistic regression.RESULTS A total of 1788 participants completed the FIT screening,with a median age of 57 years(interquartile range:40-75).Among them,503(28.1%)were males,and 1285(71.9%)were females,resulting in an 89.4%compliance rate for FIT screening.The overall positivity rate of FIT was 4.4%[79 out of 1788;95%confidence interval(CI):3%-5%].The specific positivity rates for Haikou,Sanya,Orient City,Qionghai City,and Wuzhishan City were 9.6%(45 of 468;95%CI:8%-11%),1.3%(6 of 445;95%CI:0.1%-3.1%),2.7%(8 of 293;95%CI:1.2%-4.3%),3.3%(9 of 276;95%CI:1.0%-6.3%),and 4.2%(11 of 406;95%CI:1.2%-7.3%),respectively.Significant associations were found between age,dietary habits,and positive FIT results.Out of the 79 participants with positive FIT results,55 underwent colonoscopy,demonstrating an 82.2%compliance rate.Among them,10 had a clean gastrointestinal tract,43 had polyps or adenomas,and 2 were confirmed to have CRC,yielding a positive predictive value of 3.6%(95%CI:0.9%-4.2%).Among the 43 participants with polyps or adenomas,8 were diagnosed with advanced adenomas,resulting in an advanced adenoma rate of 14.5%(95%CI:10.1%-17.7%).CONCLUSION In the Hainan region,FIT screening for CRC among asymptomatic individuals at average risk is feasible and wellreceived.
文摘BACKGROUND It has been confirmed that three-dimensional(3D)imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography(ERCP),which reduces the radiation dose and procedure time with improved safety.However,current 3D biliary imaging does not have good real-time fusion with intraoperative imaging,a process meant to overcome the influence of intraoperative respiratory motion and guide navigation.The present study explored the feasibility of real-time continuous image-guided ERCP.AIM To explore the feasibility of real-time continuous image-guided ERCP.METHODS We selected 23D-printed abdominal biliary tract models with different structures to simulate different patients.The ERCP environment was simulated for the biliary phantom experiment to create a navigation system,which was further tested in patients.In addition,based on the estimation of the patient’s respiratory motion,preoperative 3D biliary imaging from computed tomography of 18 patients with cholelithiasis was registered and fused in real-time with 2D fluoroscopic sequence generated by the C-arm unit during ERCP.RESULTS Continuous image-guided ERCP was applied in the biliary phantom with a registration error of 0.46 mm±0.13 mm and a tracking error of 0.64 mm±0.24mm.After estimating the respiratory motion,3D/2D registration accurately transformed preoperative 3D biliary images to each image in the X-ray image sequence in real-time in 18 patients,with an average fusion rate of 88%.CONCLUSION Continuous image-guided ERCP may be an effective approach to assist the operator and reduce the use of X-ray and contrast agents.
基金Supported by The Specific Research Fund of The Innovation Platform for Academicians of Hainan Province,No.YSPTZX202313The Hainan Province Clinical Medical Center,No.2021818+2 种基金The Hainan Provincial Health Industry Research Project,No.22A200078The Hainan Provincial Postgraduate Innovation Research Project,No.Qhyb2022-133The National Clinical Key Specialty Capacity Building Project,No.202330。
文摘BACKGROUND The immune microenvironment(IME)in hepatocellular carcinoma(HCC)plays a pivotal role in determining patient outcomes and responses to treatment.This area is witnessing rapid growth in research interest.However,there is a lack of comprehensive bibliometric analyses that dissect trends and potential focal points in this field.AIM To explore the evolution of research on the IME in HCC from January 1,2004,to December 31,2023,using bibliometric methodologies.METHODS English articles and reviews concerning the IME of HCC were retrieved from the Web of Science Core Collection with a search date of December 31,2023.The R package Bibliometrix was employed to compute basic bibliometric characteristics,illustrate collaborations among countries and authors,and create a three-field diagram illustrating the connections between authors,affiliations,and keywords.Analyses of country and institutional co-authorship,as well as keyword co-occurrence,were conducted using VOSviewer.Additionally,CiteSpace was utilized for the cite burst analysis of keywords and cited literature.RESULTS The study encompassed 3125 documents in the research areas related to HCC of IME,revealing a substantial and continuous increase in the annual publication trend over time.China and Hehai University emerged as leading contributors,with 2103 and 165 publications,respectively.Frontiers in immunology was the most prolific journal in this domain.Among the top ten researchers in the field,eight are based in China.Key research terms identified include tumour microenvironment,expression,immunotherapy,and prognosis.CONCLUSION The relationship between HCC and IME is receiving increasing attention,and related research is in a highly developed stage.Key focus areas,including IME and immune checkpoint inhibitors,immunotherapy are poised to be central to future research endeavors,offering promising pathways for further exploration.
