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| 1 | Solid pseudopapillary tumor of the pancreas:A review of 553 cases in Chinese literature显示文摘AIM:To sum up the clinical and pathological characte- ristics of solid pseudopapillary tumor (SPT) and the experience with it.METHODS: A total of 553 SPT patients reported in Chinese literature between January 1996 and January 2009 were retrospectively reviewed and analyzed. RESULTS: The mean age of the 553 SPT patients included in this review was 27.2 years, and the male to female ratio was 1:8.37. Their symptoms were non-specific, and nearly one third of the patients were asymptomatic. Computed tomography and ultraso-nography were performed to show the nature and location of SPT. Most of the tumors were distributed in the pancreatic head (39.8%), tail (24.1%), body andtail (19.5%). Forty-five patients (9.2%) were diagnosed as malignant SPT with metastasis or invasion. None of the clinical factors was closely related to the malignant potential of SPT. Surgery was the main therapeutic modality for SPT. Local resection, distal pancreatectomy and pancreatoduodenectomy were the most common surgical procedures. Local recurrence and hepatic metastasis were found in 11 and 2 patients, respectively, after radical resection. Four patients died of tumor progression within 4 years after palliative resection of SPT. The prognosis of SPT patients was good with a 5-year survival rate of 96.9%.CONCLUSION: SPT of the pancreas is a rare indolent neoplasm that typically occurs in young females. It is a low-grade malignancy and can be cured with extended resection. The prognosis of such patients is good although the tumor may recur and metastasize. | Yu, Peng-Fei Hu, Zhen-Hua Wang, Xin-Bao Guo, Jian-Min Cheng, Xiang-Dong Zhang, Yun-Li Xu, Qi | 2010 | World Journal of Gastroenterology2010，16，10： | 121 |
| 2 | 慢性阻塞性肺疾病诊断、处理和预防全球策略(2011年修订版)解读显示文摘自2001年颁布第1版“慢性阻塞性肺疾病诊断、处理和预防全球策略”(Global strategy for the diagnosis,management.and prevention o fchronic obstructive pulmonary disease,简称COPD全球策略)已整10年,10年中COPD研究取得了相当大的进展。2011年12月29日正式颁布的COPD全球策略2011年修订版(简称COPD全球策略修订版)[1],在原版本基础上根据COPD临床研究的最新进展进行了重大修改。 | 蔡柏蔷 | 2012 | 中华结核和呼吸杂志2012，35，4： | 155 |
| 3 | Current status and progress of pancreatic cancer in China显示文摘Cancer is currently one of the most important public health problems in the world.Pancreatic cancer is a fatal disease with poor prognosis.As in most other countries,the health burden of pancreatic cancer in China is increasing,with annual mortality rates almost equal to incidence rates.The increasing trend of pancreatic cancer incidence is more significant in the rural areas than in the urban areas.Annual diagnoses and deaths of pancreatic cancer in China are now beyond the number of cases in the United States.GLOBOCAN 2012 estimates that cases in China account for 19.45%(65727/337872) of all newly diagnosed pancreatic cancer and 19.27%(63662/330391) of all deaths from pancreatic cancer worldwide.The population's growing socioeconomic status contributes to the rapid increase of China's proportional contribution to global rates.Here,we present an overview of control programs for pancreatic cancer in China focusing on prevention,early diagnosis and treatment.In addition,we describe key epidemiological,demographic,and socioeconomic differences between China and developed countries.Facts including no nationwide screening program for pancreatic cancer,delay in early detection resulting in a late stage at presentation,lack of awareness of pancreatic cancer in the Chinese population,and low investment compared with other cancer types by government have led to backwardness in China's pancreatic cancer diagnosis and treatment.Finally,we suggest measures to improve health outcomes of pancreatic cancer patients in China. | Quan-Jun Lin Feng Yang Chen Jin De-Liang Fu | 2015 | World Journal of Gastroenterology2015，21，26： | 93 |
| 4 | 影像组学的发展与应用显示文摘近年来大数据技术与医学影像辅助诊断的有机融合产生了新的影像组学方法,其通过从影像中提取海量特征来量化肿瘤等重大疾病,可以有效解决肿瘤异质性难以定量评估的问题,具有重要的临床价值。影像组学技术来源于计算机辅助诊断(computer aided diagnosis,CAD),目前已经发展成为融合影像、基因、临床等信息的辅助诊断、分析和预测的方法。影像组学作为医工交叉的产物,其应用先进的计算机方法解决临床具体问题,将有广阔的应用前景。笔者将对新兴的影像组学技术进行介绍,阐述影像组学的相关概念、具体处理流程及其面临的挑战、应用领域及未来的发展方向。 | 张利文 方梦捷 臧亚丽 朱永北 董迪 刘侠 田捷 | 2017 | 中华放射学杂志2017，51，1： | 117 |
| 5 | The Chinese Society of Clinical Oncology(CSCO):clinical guidelines for the diagnosis and treatment of gastric cancer显示文摘China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selection between gastric cancer patients from the Eastern and Western countries.Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients.The Chinese Society of Clinical Oncology(CSCO)arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile,discuss,and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad.By referring to the opinions of industry experts,taking into account of regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted experts’consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes.This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis,comprehensive treatment,and follow-up visits for gastric cancer. | Feng-Hua Wang Lin Shen Jin Li Zhi-Wei Zhou Han Liang Xiao-Tian Zhang Lei Tang Yan Xin Jing Jin Yu-Jing Zhang Xiang-Lin Yuan Tian-Shu Liu Guo-Xin Li Qi Wu Hui-Mian Xu Jia-Fu Ji Yuan-Fang Li Xin Wang Shan Yu Hao Liu Wen-Long Guan Rui-Hua Xu | 2019 | Cancer Communications2019，39，1： | 127 |
| 6 | The Chinese Society of Clinical Oncology(CSCO):Clinical guidelines for the diagnosis and treatment of gastric cancer,2021显示文摘There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and Western countries.The Chinese Society of Clinical Oncology(CSCO)has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually.Taking into account regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China.The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis,treatment,follow-up,and screening of gastric cancer.Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines,this updated guideline integrates the results ofmajor clinical studies from China and overseas for the past year,focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations.For the comprehensive treatment of non-metastatic gastric cancer,attentions were paid to neoadjuvant treatment.The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated.For the comprehensive treatment of metastatic gastric cancer,recommendations for immunotherapy were included,and immune checkpoint inhibitors fromthird-line to the first-line of treatment for different patient groups with detailed notes are provided. | Feng-Hua Wang Xiao-Tian Zhang Yuan-Fang Li Lei Tang Xiu-Juan Qu Jie-Er Ying Jun Zhang Ling-Yu Sun Rong-Bo Lin Hong Qiu Chang Wang Miao-Zhen Qiu Mu-Yan Cai QiWu Hao Liu Wen-Long Guan Ai-Ping Zhou Yu-Jing Zhang Tian-Shu Liu Feng Bi Xiang-Lin Yuan Sheng-Xiang Rao Yan Xin Wei-Qi Sheng Hui-Mian Xu Guo-Xin Li Jia-Fu Ji Zhi-Wei Zhou Han Liang Yan-Qiao Zhang Jing Jin Lin Shen Jin Li Rui-Hua Xu | 2021 | Cancer Communications2021，41，8： | 97 |
| 7 | Diagnosis and management of insulinoma显示文摘Insulinomas,the most common cause of hypoglycemia related to endogenous hyperinsulinism,occur in 1-4 people per million of the general population.Common autonomic symptoms of insulinoma include diaphroresis,tremor,and palpitations,whereas neuroglycopenenic symptoms include confusion,behavioural changes,personality changes,visual disturbances,seizure,and coma.Diagnosis of suspected cases is based on standard endocrine tests,especially the prolonged fasting test.Non-invasive imaging procedures,such as computed tomography and magnetic resonance imaging,are used when a diagnosis of insulinoma has been made to localize the source of pathological insulin secretion.Invasive modalities,such as endoscopic ultrasonography and arterial stimulation venous sampling,are highly accurate in the preoperative localization of insulinomas and have frequently been shown to be superior to noninvasive localization techniques.The range of techniques available for the localization of insulinomas means thatblind resection can be avoided.Intraoperative manual palpation of the pancreas by an experienced surgeon and intraoperative ultrasonography are both sensitive methods with which to finalize the location of insulinomas.A high proportion of patients with insulinomas can be cured with surgery.In patients with malignant insulinomas,an aggressive medical approach,including extended pancreatic resection,liver resection,liver transplantation,chemoembolization,or radiofrequency ablation,is recommended to improve both survival and quality of life.In patients with unresectable or uncontrollable insulinomas,such as malignant insulinoma of the pancreas,several techniques should be considered,including administration of ocreotide and/or continuous glucose monitoring,to prevent hypoglycemic episodes and to improve quality of life. | Takehiro Okabayashi Yasuo Shima Tatsuaki Sumiyoshi Akihito Kozuki Satoshi Ito Yasuhiro Ogawa Michiya Kobayashi Kazuhiro Hanazaki | 2013 | World Journal of Gastroenterology2013，19，6： | 78 |
| 8 | Current clinical management of gastrointestinal stromal tumor显示文摘Gastrointestinal stromal tumors(GISTs) are the most common malignant subepithelial lesions(SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1(DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography(EUS) and EUS-guided fine needle aspiration(EUSFNA) are critical for an accurate diagnosis of SELs. EUSFNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs. | Kazuya Akahoshi Masafumi Oya Tadashi Koga Yuki Shiratsuchi | 2018 | World Journal of Gastroenterology2018，24，26： | 70 |
| 9 | Recent advances in gastric cancer early diagnosis显示文摘Gastric cancer(GC) remains an important cause of cancer death worldwide with a high mortality rate due to the fact that the majority of GC cases are diagnosed at an advanced stage when the prognosis is poor and the treatment options are limited. Unfortunately, the existing circulating biomarkers for GC diagnosis and prognosis display low sensitivity and specificity and the GC diagnosis is based only on the invasive procedures such as upper digestive endoscopy. There is a huge need for less invasive or non-invasive tests but also highly specific biomarkers in case of GC. Body fluids such as peripheral blood, urine or saliva,stomach wash/gastric juice could be a source of specific biomarkers, providing important data for screening and diagnosis in GC. This review summarized the recently discovered circulating molecules such as microRNAs, long non-coding RNAs, circular RNAs, which hold the promise to develop new strategies for early diagnosis of GC. | Laura Necula Lilia Matei Denisa Dragu Ana I Neagu Cristina Mambet Saviana Nedeianu Coralia Bleotu Carmen C Diaconu Mihaela Chivu-Economescu | 2019 | World Journal of Gastroenterology2019，25，17： | 70 |
| 10 | Artificial intelligence in healthcare:past,present and future显示文摘Artificial intelligence(AI)aims to mimic human cognitive functions.It is bringing a paradigm shift to healthcare,powered by increasing availability of healthcare data and rapid progress of analytics techniques.We survey the current status of AI applications in healthcare and discuss its future.AI can be applied to various types of healthcare data(structured and unstructured).Popular AI techniques include machine learning methods for structured data,such as the classical support vector machine and neural network,and the modern deep learning,as well as natural language processing for unstructured data.Major disease areas that use AI tools include cancer,neurology and cardiology.We then review in more details the AI applications in stroke,in the three major areas of early detection and diagnosis,treatment,as well as outcome prediction and prognosis evaluation.We conclude with discussion about pioneer AI systems,such as IBM Watson,and hurdles for real-life deployment of AI. | Fei Jiang Yong Jiang Hui Zhi Yi Dong Hao Li Sufeng Ma Yilong Wang Qiang Dong Haipeng Shen Yongjun Wang | 2017 | Stroke & Vascular Neurology2017，2，4： | 76 |
| 11 | Update on cerebral small vessel disease: a dynamic whole-brain disease显示文摘Cerebral small vessel disease(CSVD)is a very common neurological disease in older people.It causes stroke and dementia,mood disturbance and gait problems.Since it is difficult to visualise CSVD pathologies in vivo,the diagnosis of CSVD has relied on imaging findings including white matter hyperintensities,lacunar ischaemic stroke,lacunes,microbleeds,visible perivascular spaces and many haemorrhagic strokes.However,variations in the use of definition and terms of these features have probably caused confusion and difficulties in interpreting results of previous studies.A standardised use of terms should be encouraged in CSVD research.These CSVD features have long been regarded as different lesions,but emerging evidence has indicated that they might share some common intrinsic microvascular pathologies and therefore,owing to its diffuse nature,CSVD should be regarded as a‘whole-brain disease’.Single antiplatelet(for acute lacunar ischaemic stroke)and management of traditional risk factors still remain the most important therapeutic and preventive approach,due to limited understanding of pathophysiology in CSVD.Increasing evidence suggests that new studies should consider drugs that target endothelium and blood–brain barrier to prevent and treat CSVD.Epidemiology of CSVD might differ in Asian compared with Western populations(where most results and guidelines about CSVD and stroke originate),but more community-based data and clear stratification of stroke types are required to address this. | Yulu Shi Joanna M Wardlaw | 2016 | Stroke & Vascular Neurology2016，1，3： | 74 |
| 12 | Chinese Society of Clinical Oncology (CSCO) diagnosis and treatment guidelines for colorectal cancer 2018(English version)显示文摘Contents1. General guidelines for diagnosis and treatment of colorectal cancer2. Diagnostic principles for colorectal cancer2.1 Colorectal cancer screening of asymptomatic healthy population2.2 Basic diagnostic principles2.2.1 Colorectal cancer diagnosis2.2.2 Appendix on colorectal cancer imaging staging and diagnosis2.3 Principles of pathological diagnosis2.4 Staging. | Chinese Society of Clinical Oncology(CSCO)diagnosis and treatment guidelines for colorectal cancer working group Suzhan Zhang Jin Li Sanjun Cai Ruihua Xu Zhen Zhang | 2019 | Chinese Journal of Cancer Research2019，31，1： | 66 |
| 13 | Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine显示文摘Irritable bowel syndrome(IBS)is a chronic and debilitating functional gastrointestinal disorder that affects9%-23%of the population across the world.The percentage of patients seeking health care related to IBS approaches 12%in primary care practices and is by far the largest subgroup seen in gastroenterology clinics.It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis.The pathophysiology of IBS is not clear.Many theories have been put forward,but the exact cause of IBS is still uncertain.According to the updated ROMEⅢcriteria,IBS is a clinical diagnosis and presents as one of the three predominant subtypes:(1)IBS with constipation(IBS-C);(2)IBS with diarrhea(IBS-D);and(3)mixed IBS(IBS-M);former ROME definitions refer to IBS-M as alternating IBS(IBS-A).Across the IBS subtypes,the presentation of symptoms may vary among patients and change over time.Patients report the most distressing symptoms to be abdominal pain,straining,myalgias,urgency,bloating and feelings of serious illness.The complexity and diversity of IBS presentation makes treatment difficult.Although there are reviews and guidelines for treating IBS,they focus on the efficacy of medications for IBS symptoms usinghigh-priority endpoints,leaving those of lower priority largely unreported.Therefore,the aim of this review is to provide a comprehensive evidence-based review of the diagnosis,pathogenesis and treatment to guide clinicians diagnosing and treating their patients. | Lekha Saha | 2014 | World Journal of Gastroenterology2014，20，22： | 65 |
| 14 | Diagnosis of Helicobacter pylori infection: Current options and developments显示文摘Accurate diagnosis of Helicobacter pylori(H. pylori) infection is a crucial part in the effective management of many gastroduodenal diseases. Several invasive and non-invasive diagnostic tests are available for the detection of H. pylori and each test has its usefulness and limitations in different clinical situations. Although none can be considered as a single gold standard in clinical practice,several techniques have been developed to give the more reliable results. Invasive tests are performed via endoscopic biopsy specimens and these tests include histology,culture,rapid urease test as well as molecular methods. Developments of endoscopic equipment also contribute to the real-time diagnosis of H. pylori during endoscopy. Urea breathingtest and stool antigen test are most widely used noninvasive tests,whereas serology is useful in screening and epidemiological studies. Molecular methods have been used in variable specimens other than gastric mucosa. More than detection of H. pylori infection,several tests are introduced into the evaluation of virulence factors and antibiotic sensitivity of H. pylori,as well as screening precancerous lesions and gastric cancer. The aim of this article is to review the current options and novel developments of diagnostic tests and their applications in different clinical conditions or for specific purposes. | Yao-Kuang Wang Fu-Chen Kuo Chung-Jung Liu Meng-Chieh Wu Hsiang-Yao Shih Sophie SW Wang Jeng-Yih Wu Chao-Hung Kuo Yao-Kang Huang Deng-Chyang Wu | 2015 | World Journal of Gastroenterology2015，21，40： | 66 |
| 15 | Diagnostic value of glypican-3 in serum and liver for primary hepatocellular carcinoma显示文摘AIM:To evaluate the diagnostic value of glypican-3(GPC3) in serum and liver for primary hepatocellular carcinoma(HCC).METHODS:Serum levels of GPC3 and α-fetoprotein(AFP) were measured in 75 patients with primary HCC and 32 patients with liver cirrhosis.Expression of GPC3 and AFP in 58 HCC and 12 cirrhotic specimens was detected with immunohistochemical staining.RESULTS:When the cut-off value of serum GPC3 was set at 300 ng/L,its sensitivity and specificity for HCC were 47.0% and 93.5%,respectively.Among the 14 patients with HCC at stage according to the Barcelona Clinic Liver Cancer staging system,the serum GPC3 level was higher than 300 ng/L in 50%(7/14) patients,the serum AFP level was not ≥ 400 μg/L in any patient.Combined serum AFP and GPC3 significantly increased the sensitivity to the diagnosis of HCC.The GPC3 expression was detected in cytoplasm of HCC cells but not in hepatocytes and bile ducts of benign tumors.Among the 58 HCC patients,the GPC3 was expressed in 100%(28/28) patients with their serum AFP level ≥ 400 μg/L,and in 90%(27/30) patients with their AFP level < 400 μg/L,respectively.The GPC3 was weakly or negatively expressed in all paracarcinomatous and cirrhotic tissue samples.AFP positive HCC cells were only found in 1 out of the 58 HCC patients.CONCLUSION:GPC3 protein is a sensitive and specific serum marker for diagnosis of early HCC.Its expression in liver tissues can be used to discriminate tumor cells from benign hepatic cells. | Hui Liu Li-Jie Zhang Peng Li Yun Zhai Yu-Fen Tan Ning Li Hui-Guo Ding Chun-Feng Qu | 2010 | World Journal of Gastroenterology2010，16，35： | 57 |
| 16 | Specific molecular markers in hepatocellular carcinoma显示文摘BACKGROUND: The carcinogenesis of hepatocellular carcinoma (HCC) is a multi-factorial, multistep and complex process. Its prognosis is poor, and early diagnosis and monitoring metastasis of HCC is of the utmost importance. Circulating diagnostic and prognostic biomarkers could be used in proper postoperative treatment of patients at an early stage of HCC development. This review summarizes recent studies of the specific biomarkers in diagnosis and monitoring metastasis or postoperative recurrence of HCC. DATA SOURCES: An English-language literature search was conducted using MEDLINE (June 1998 to September 2006) on researches of some valuable specific biomarkers in diagnosis and monitoring metastasis or postoperative recurrence of HCC. RESULTS: Hepatoma tissues can synthesize various tumor-related proteins, polypeptides, and isoenzymes, such as alpha-fetoprotein (AFP), hepatoma-specific gamma-glutamyl transpeptidase (HS-GGT), etc, and then secrete into blood. The valuable early diagnostic and prognostic biomarkers could predict the development and metastases of HCC. Recent researches have confirmed that circulating hepatoma-specific AFP subfraction, transforming growth factor (TGF)-β1, HS-GGT, and free insulin-like growth factor (IGF)-Ⅱ may be more specific markers than total AFP level for early diagnosis for HCC. The circulating genetic markers such as AFP-mRNA, TGF-β1-mRNA, IGF-Ⅱ-mRNA, etc from peripheral blood mononuclear cells of HCC patients have been most extensively used in monitoring distal metastasis or postoperative recurrence of HCC. CONCLUSIONS: Hepatoma tissues synthesize and secrete valuable molecular markers into blood. The analyses of circulating hepatoma-specific biomarkers are usefulto early diagnosis of HCC or monitoring metastasis or postoperative recurrence of HCC. | Yao, Deng-Fu Dong, Zhi-Zhen Yao, Min | 2007 | Hepatobiliary & Pancreatic Diseases International2007，6，3： | 55 |
| 17 | An insight into the diagnosis and pathogenesis of hepatitis C virus infection显示文摘This review focuses on research findings in the area of diagnosis and pathogenesis of hepatitis C virus(HCV)infection over the last few decades.The information based on published literature provides an update on these two aspects of HCV.HCV infection,previously called blood transmitted non-A,non-B infection,is prevalent globally and poses a serious public health problem worldwide.The diagnosis of HCV infection has evolved from serodetection of non-specific and low avidity anti-HCV antibodies to detection of viral nucleic acid in serum using the polymerase chain reaction(PCR)technique.Current PCR assays detect viral nucleic acid with high accuracy and the exact copy number of viral particles.Moreover,multiplex assays using real-time PCR are available for identification of HCV-genotypes and their isotypes.In contrast to previous methods,the newly developed assays are not only fast and eco-nomic,but also resolve the problem of the window period as well as differentiate present from past infection.HCV is a non-cytopathic virus,thus,its pathogenesis is regulated by host immunity and metabolic changes including oxidative stress,insulin resistance and hepatic steatosis.Both innate and adaptive immunity play an important role in HCV pathogenesis.Cytotoxic lymphocytes demonstrate crucial activity during viral eradication or viral persistence and are influenced by viral proteins,HCV-quasispecies and several metabolic factors regulating liver metabolism.HCV pathogenesis is a very complex phenomenon and requires further study to determine the other factors involved. | Mohammad Irshad Dhananjay Singh Mankotia Khushboo Irshad | 2013 | World Journal of Gastroenterology2013，19，44： | 52 |
| 18 | Missed diagnosis of early gastric cancer or high-grade intraepithelial neoplasia显示文摘AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected by esophagogastroduodenos-copy (EGD) and pathological analysis from January 2010 to December 2011. Dimethyl silicone oil was administrated orally 15 min before the EGD procedures. The stomach was cleaned by repeated washing with saline when the gastroscope entered the stomach cavity. Suspected EGC lesions were subject to conventional biopsy sampling and pathological examinations. The correlation between lesion locations, endoscopic morphology of cancerous sites, training level of the examiners, pathological biopsies, and missed diagnosis was analyzed. RESULTS: Twenty-three cases were missed among the 103 cases (22.23%) of EGC/HGIN. The rate of missed EGC in the gastroesophageal junction (8/19, 42.1%) was significantly higher than at other sites (15/84, 17.86%) (χ2 = 5.253, P = 0.022). In contrast, the rate of missed EGC in the lower stomach body (2/14, 14.29%) was lower than at other sites (21/89,23.6%), but there were no significant differences (χ2 = 0.289, P = 0.591). The rate of missed EGC in the gastric antrum (5/33, 15.15%) was lower than at other sites (18/70, 25.71%), but there were no significant differences (χ2 = 1.443, P = 0.230). Endoscopists from less prestigious hospitals were more prone to not diagnosing EGC than those from more prestigious hospitals (χ2 = 4.261, P = 0.039). When the number of biopsies was < 4, the rate of missed diagnosis was higher (20/23, 89.96%) than for when there were > 4 biopsies (3/23, 13.04%) (P < 0.001). In addition, there was no significant difference in the rate of missed diagnosis in patients with 1-3 biopsy specimens (χ2 = 0.141, P = 0.932). CONCLUSION: Endoscopists should have a clear understanding of the anatomical characteristics of the esophagus/stomach, and endoscopic identification of early lesions increases with the number of biopsies. | Wei Ren Jin Yu Zhi-Mei Zhang Yuan-Kun Song Yi-Hui Li Lei Wang | 2013 | World Journal of Gastroenterology2013，19，13： | 58 |
| 19 | Diagnostic value of AFP-L3 and PIVKA-Ⅱin hepatocellular carcinoma according to total-AFP显示文摘AIM:To evaluate diagnostic value ofα-fetoprotein (AFP)-L3 and prothrombin induced by vitamin K absence-Ⅱ(PIVKA-Ⅱ)in hepatocellular carcinoma(HCC). METHODS:One hundred and sixty-eight patients during routine HCC surveillance were included in this study.Of the 168 patients,90(53.6%)had HCC including newly developed HCC(n=82)or recurrent HCC after treatment(n=8).Sera were obtained during their first evaluation for HCC development and at the time of HCC diagnosis before commencing HCC treatment.HCC was diagnosed by histological examination,appropriate imaging characteristics-computed tomography or magnetic resonance imaging.Control sera were collected from 78 patients with benign liver disease(BLD),which were obtained during routine surveillance with a suspicion of HCC.AFP,AFP-L3 and PIVKA-Ⅱwere measured in the same serum by microchip capillary electrophoresis and liquid-phase binding assay on a micro-total analysis system Wako i30 auto analyzer.The performance characteristics of three tests and combined tests for the diagnosis of HCC were obtained using receiver operating characteristic curves in all populations and subgroups with AFP<20 ng/mL. RESULTS:Of 90 HCC patients,38(42.2%)patients had AFP<20 ng/mL,20(22.2%)patients had AFP 20-200 ng/mL and 32(35.6%)patients had AFP>200 ng/mL.Of the 78 BLD patients,74(94.9%)patients had AFP<20 ng/mL.After adjustment for age and HBV infection status,AFP-L3 levels were higher in HCC than in BLD among patients with low AFP levels(<20 ng/mL)(P<0.001).In a total of 168 patients,areas under the curve(AUC)for HCC were 0.879,0.887,0.801 and 0.939 for AFP,AFP-L3,PIVKA-Ⅱand the combined markers,respectively.The combined AUC for three markers showed higher value than the AUCs of individual marker(P<0.05).AFP-L3 had higher AUC value than PIVKA-Ⅱfor HCC detection in entire patients(P =0.043).With combination of AFP-L3(cut-off>5%) and PIVKA-Ⅱ(cut-off>40 AU/L),the sensitivity were 94.4%and specificity were 75.6%in all patients.In 112 patients with low AFP levels(<20 ng/mL),AUCs of AFP-L3,PIVKA-Ⅱand combine AFP-L3 and PIVKA-Ⅱtests were 0.824,0.774 and 0.939,respectively. AFP-L3 with a cut-off value of 5%showed sensitivity of 71.1%and specificity of 83.8%,and PIVKA-Ⅱwith a cut-off value of 40 AU/L had sensitivity of 57.9%and specificity of 95.9%in patients with low AFP levels. The combination of AFP-L3 and PIVKA-Ⅱincreased the sensitivity and specificity up to 92.1%and 79.7%, respectively,in low AFP group.Combined markers detected 81.8%of early stage HCC(Union for Inter-national Cancer Control stageⅠ),86.7%of small sized tumor(<2 cm)and 91.7%of single tumor of HCC in the low AFP group.In multivariate analysis,AFP-L3 was correlated with AFP and tumor size,and PIVKA-Ⅱwas correlated with laboratory tests including serum aspartate aminotransferase,total bilirubin,platelets and albumin levels.PIVKA-Ⅱhad no correlation with AFP,AFP-L3 or tumor characteristics. CONCLUSION:Combined determination of AFP-L3 and PIVKA-Ⅱcould improve the diagnostic value for HCC detection in patients with or without increased AFP levels. | Jong Young Choi Seung Won Jung Hee Yeon Kim Myungshin Kim Yonggoo Kim Dong Goo Kim Eun-Jee Oh | 2013 | World Journal of Gastroenterology2013，19，3： | 55 |
| 20 | Review of a challenging clinical issue:Intrahepatic cholestasis of pregnancy显示文摘Intrahepatic cholestasis of pregnancy(ICP) is a reversible pregnancy-specific cholestatic condition characterized by pruritus, elevated liver enzymes, and increased serum bile acids. It commences usually in the late second or third trimester, and quickly resolves after delivery. The incidence is higher in South American and Scandinavian countries(9.2%-15.6% and 1.5%, respectively) than in Europe(0.1%-0.2%). The etiology is multifactorial where genetic, endocrine, and environmental factors interact. Maternal outcome is usually benign, whereas fetal complications such as preterm labor, meconium staining, fetal distress, and sudden intrauterine fetal demise not infrequently lead to considerable perinatal morbidity and mortality. Ursodeoxycholic acid is shown to be the most efficient therapeutic agent with proven safety and efficacy. Management of ICP consists of careful monitoring of maternal hepatic function tests and serum bile acid levels in addition to the assessment of fetal well-being and timely delivery after completion of fetal pulmonary maturity. This review focuses on the current concepts about ICP based on recent literature data and presents an update regarding the diagnosis and management of this challenging issue. | Sebiha Ozkan Yasin Ceylan Orhan Veli Ozkan Sule Yildirim | 2015 | World Journal of Gastroenterology2015，21，23： | 53 |
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