The oral bacterial microbiota facilitates the stratification for ulcerative colitis patients with oral ulcers.

BACKGROUND: Clinically, a large part of inflammatory bowel disease (IBD) patients is complicated by oral lesions. Although previous studies proved oral microbial dysbiosis in IBD patients, the bacterial community in the gastrointestinal (GI) tract of those IBD patients combined with oral ulcers has not been profiled yet. METHODS: In this study, we enrolled four groups of subjects, including healthy controls (CON), oral ulcer patients (OU), and ulcerative colitis patients with (UC_OU) and without (UC) oral ulcers. Bio-samples from three GI niches containing salivary, buccal, and fecal samples, were collected for 16S rRNA V3-V4 region sequencing. Bacterial abundance and related bio-functions were compared, and data showed that the fecal microbiota was more potent than salivary and buccal microbes in shaping the host immune system. ~ 22 UC and 10 UC_OU 5-aminosalicylate (5-ASA) routine treated patients were followed-up for six months; according to their treatment response (a decrease in the endoscopic Mayo score), they were further sub-grouped as responding and non-responding patients. RESULTS: We found those UC patients complicated with oral ulcers presented weaker treatment response, and three oral bacterial genera, i.e., Fusobacterium, Oribacterium, and Campylobacter, might be connected with treatment responding. Additionally, the salivary microbiome could be an indicator of treatment responding in 5-ASA routine treatment rather than buccal or fecal ones. CONCLUSIONS: The fecal microbiota had a strong effect on the host's immune indices, while the oral bacterial microbiota could help stratification for ulcerative colitis patients with oral ulcers. Additionally, the oral microbiota had the potential role in reflecting the treatment response of UC patients. Three oral bacteria genera (Fusobacterium, Oribacterium, and Campylobacter) might be involved in UC patients with oral ulcers lacking treatment responses, and monitoring oral microbiota may be meaningful in assessing the therapeutic response in UC patients.

Nonalcoholic fatty liver disease aggravates acute pancreatitis through bacterial translocation and cholesterol metabolic dysregulation in the liver and pancreas in mice.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for severe acute pancreatitis (AP). The underlying mechanism remains unclear. We sought to determine how bacterial translocation and cholesterol metabolism in the liver and pancreas affect the severity of AP in NAFLD mice. METHODS: C57BL/6N mice were fed on a high-fat diet (HFD) to generate the NAFLD model, and mice in the control group were provided with a normal diet (ND). After being anesthetized with ketamine/xylazine, mice got a retrograde infusion of taurocholic acid sodium into the pancreatic duct to induce AP, and sham operation (SO) was used as control. Serum amylase and Schmidt's pathological score system were used to evaluate AP severity. Bacterial loads, total cholesterol level, and cholesterol metabolic-associated molecules [low-density lipoprotein receptor (LDLR) and ATP-binding cassette transporter A1 (ABCA1)] were analyzed in the liver and pancreas. RESULTS: Compared with the ND-AP group, mice in the HFD-AP group had severer pancreatitis, manifested with higher serum amylase levels and higher AP pathologic scores, especially the inflammation and hemorrhage scores. Compared with the HFD-SO group and ND-AP group, bacterial loads in the liver and pancreas were significantly higher in the HFD-AP group. Mice in the HFD-AP group showed a decreased LDLR expression and an increased ABCA1 expression in the pancreas, although there was no significant difference in pancreas total cholesterol between the HFD-AP group and the ND-AP group. CONCLUSIONS: NAFLD aggravates AP via increasing bacterial translocation in the liver and pancreas and affecting pancreas cholesterol metabolism in mice.

Combined Scores from the EncephalApp Stroop Test, Number Connection Test B, and Serial Dotting Test Accurately Identify Patients With Covert Hepatic Encephalopathy.

BACKGROUND & AIMS: The EncephalApp Stroop test is a high-sensitivity but low-specificity test that has been used to identify patients with covert hepatic encephalopathy (CHE). We aimed to develop a new strategy to detect CHE, combining EncephalApp Stroop test score with scores from subtests of the psychometric hepatic encephalopathy scoring system (PHES). METHODS: We performed a survey of 569 adult volunteers (229 men) in 9 communities in Shanghai, China, administering the EncephalApp Stroop test to determine the range of scores in the general population. Data from the standard PHES, including the number connection test-A, number connection test-B (NCT-B), line tracing test, serial dotting test (SDT), and digit symbol test, were used as the reference standard for diagnosis of CHE. A combination of the EncephalApp Stroop with subtests of the PHES was used to establish a new strategy for CHE diagnosis. We validated our findings using data from 160 patients with cirrhosis from 5 centers China. RESULTS: We determined the range of EncephalApp Stroop test scores for the volunteers of different decades of age, education levels, and sexes. Age, education level, and sex were independently associated with EncephalApp Stroop test scores. A combination of scores from the EncephalApp Stroop test, the NCT-B, and the SDT identified patients with CHE with the highest level of accuracy, when the standard PHES was used as the reference standard. A combination of scores of 187 sec for the EncephalApp Stroop test and below -1 for the NCT-B or below -1 for the SDT identified patients with CHE with an area under the curve (AUC) of 0.86, 81.0% sensitivity, and 91.9% specificity, and 87.5% accuracy. In the validation cohort, these cutoff scores identified patients with CHE with an AUC of 0.88, 97.1% sensitivity, 79.3% specificity, and 86.9% accuracy. The average time to calculate this score was 374±140 sec, compared 424±115 sec for the entire PHES. CONCLUSION: Scores from the EncephalApp Stroop test, NCT-B, and SDT identify patients with CHE with approximately 87% accuracy, and in a much shorter time than the standard PHES. This score combination could be a valid and convenient method for identifying patients with CHE. chictr.org.cn number, ChiCTR-EDC-17012007, ChiCTR1800019954.

Utility of the EncephalApp Stroop Test for covert hepatic encephalopathy screening in Chinese cirrhotic patients.

BACKGROUND AND AIM: Considering the large size of the potential population and limitations of common detection methods, covert hepatic encephalopathy (CHE) is difficult to screen for routinely. The present study aims to explore EncephalApp Stroop Test as a smartphone-based CHE screening tool in China. METHODS: A multicenter, single-visit study was carried out. The cutoff of the Chinese EncephalApp translation was determined by using Chinese standardized psychometric hepatic encephalopathy score (PHES) in cirrhotic patients as the gold standard. Indicators reflecting time required and number of tests on subtask on (naming the color of pound signs) and off (naming the color of the word in discordant coloring) were recorded, with the feedback from investigators and patients. RESULTS: One hundred forty-four patients were included; 58 (40.28%) patients were diagnosed with CHE by PHES. The cutoff of > 97.34 s for off time and > 186.63 s for on time + off time had the maximum area under the curve values (0.77) in all patients. Furthermore, with the cutoff of 186.63 s, on time + off time has the highest sensitivity (0.86). However, the specificity was unsatisfactory (0.59). Age and alcoholic hepatitis (odds ratio = 1.05 and 3.12, both P < 0.05) were positively correlated with the risk of CHE. The experience with electronic devices and education duration were negatively correlated (odds ratio = 0.21 and 0.92, both P < 0.05). Compared with PHES, EncephalApp represented 38% time saving. Furthermore, it was superior to PHES regarding accessibility, convenience, and acceptability by administrators (all P < 0.05). CONCLUSIONS: The EncephalApp Stroop Test is an efficient screening tool for CHE in Chinese cirrhotic patients.

Roles of microRNAs in immunopathogenesis of non-alcoholic fatty liver disease revealed by integrated analysis of microRNA and mRNA expression profiles.

BACKGROUND: The integrative analysis of microRNA and mRNA expression profiles can elucidate microRNA-targeted gene function. We used this technique to elucidate insights into the immunological pathology of non-alcoholic fatty liver disease (NAFLD). METHODS: We analyzed differentially expressed microRNA and mRNA expression profiles of CD4+ T lymphocytes from the liver and mesenteric lymph nodes (MLNs) of mice with NAFLD using microarrays and RNA sequencing. Normal mice were used as controls. The target genes of microRNAs were predicted by TargetScan. Integrative analysis showed that the mRNAs were overlapped with microRNAs. Furthermore, the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to predict the key genes and pathways. Then, 16 microRNAs and 10 mRNAs were validated by qRT-PCR. RESULTS: Microarray analysis suggested that 170 microRNAs were significantly de-regulated in CD4+ T lymphocytes from the liver between the two groups. Eighty mRNAs corresponded with microRNA targeted genes. KEGG analysis indicated that the MAPK pathway was consistently augmented in the liver of NAFLD mice. miR-23b, let-7e, miR-128 and miR-130b possibly played significant parts in the MAPK pathways. Furthermore, between the two groups, 237 microRNAs were significantly de-regulated in CD4+ T lymphocytes from MLNs. 38 mRNAs coincided with microRNA target genes. The metabolic pathway was consistently enriched in the MLNs of NAFLD mice. miR-206-3p, miR-181a-5p, miR-29c-3p and miR-30d-5p likely play important roles in the regulation of metabolic pathways. CONCLUSION: The results of this study presented a new perspective on the application of integrative analysis to identify complex regulation means involved in the immunological pathogenesis of NAFLD.

Structural Characterization of Lignin in Fruits and Stalks of Chinese Quince.

Chinese quince (Chaenomeles sinensis) is used in food and pharmaceutical products, but it is seldom eaten as a raw fruit due to its astringent, woody flesh. The structural characterization of lignin fractions from Chinese quince was very important to investigate the structure-activity relationships of lignin. In this investigation, to characterize the structure of lignin in Chinese quince fruits, the milled wood lignin sample was isolated from the fruits (FMWL) and the chemical structure of FMWL was investigated by sugar analysis, FT-IR, GPC, pyrolysis-GC/MS analysis, UV spectra analysis, thermogravimetric analysis (TGA), and advanced NMR spectroscopic techniques. In addition, the lignin fraction from the stalk of Chinese quince (SMWL) was also prepared for comparison to obtained more information of lignin structure in the fruits. The results showed that the two lignin fractions isolated from fruit and stalk of Chinese quince exhibited different structural features. The two MWL samples were mainly composed of ß-O-4 ether bonds, ß-5 and ß-ß' carbon-carbon linkages in the lignin structural units. Compared to the SMWL, the FMWL fraction had the higher S/G ratio and more carbohydrates linkages. The predominant carbohydrates associated with FMWL and SMWL fractions were glucans-type hemicelluloses and xylan-type hemicelluloses, respectively. Understanding the structure of lignin could give insight into the properties of the lignin and enable the food processing industry to separate lignin more efficiently.

Genetic variants of CDH13 determine the susceptibility to chronic obstructive pulmonary disease in a Chinese population.

AIM: Adiponectin has been implicated in the development of chronic obstructive pulmonary disease (COPD). The CDH13 gene encodes T-cadherin that is an adiponectin receptor, and genetic variants of CDH13 determine blood adiponectin levels. The aim of this study was to investigate the effects of CDH13 variants on COPD susceptibility in a Chinese population. METHODS: Ten single-nucleotide polymorphisms (SNP) in CDH13 were screened using the SNaPshot method in 279 COPD patients and 367 control subjects. Association of genotypes or haplotypes constructed from these loci with COPD was analyzed in different genetic models. RESULTS: Among the 10 SNPs tested, rs4783244 and rs12922394 exhibited significant differences in allele or genotype frequencies between COPD patients and control subjects, whereas 8 other SNPs did not. The minor allele T was associated with decreased risk of COPD in the recessive model at rs4783244 (OR=0.42, P=0.023) and in the dominant model at rs12922394 (OR=0.70, P=0.022). The genotype TT at either rs4783244 or rs12922394 was associated with a significantly low level of plasma adiponectin when compared to genotypes GG and CC (P<0.05). Haplotypes GC in block 1 (rs4783244-rs12922394) as well as GTAC and ATGT in block 3 (rs4783266-rs11640522-rs11646849-rs11860282) significantly increased the risk of COPD, whereas haplotypes TT in block 1, TG in block 2 (rs11646011- rs11640875) and ATGC in block 3 were protective against COPD. CONCLUSION: CDH13 genetic variants determine Chinese individuals' susceptibility to COPD and thus are efficient genetic biomarkers for early detection of COPD.

One-step solvent extraction followed by liquid chromatography-atmospheric pressure photoionization tandem mass spectrometry for the determination of polycyclic aromatic hydrocarbons in edible oils.

A method for rapid analysis of 16 polycyclic aromatic hydrocarbons (PAHs) in edible oils has been developed on the basis of a simplified solvent extraction and liquid chromatography-atmospheric pressure photoionization tandem mass spectrometry performed in multiple reaction monitoring mode. The briefness of the experimental procedure, the use of milliliters of acetonitrile for extraction without any further cleanup process, the short analysis time, and the excellent sensitivity and selectivity demonstrated the advantages of this practical and environmentally friendly method. All the analytes exhibited satisfactory recoveries at three spiking levels (the recoveries ranged from 77.8 to 106.4%), and the relative standard deviations were lower than 10%. The limits of quantitation of this method for the 16 PAHs were in the range of 0.02-0.43 µg/kg. The validated method was successfully applied for the determination of PAHs in coconut oil reference material (BCR-458) and real edible oil samples. The results suggested that a large-scale investigation of the concentration of PAHs in vegetable oils in China is required.

Analysis of MicroRNA Expression Profiles in Weaned Pig Skeletal Muscle after Lipopolysaccharide Challenge.

MicroRNAs (miRNAs) constitute a class of non-coding RNAs that play a crucial regulatory role in skeletal muscle development and disease. Several acute inflammation conditions including sepsis and cancer are characterized by a loss of skeletal muscle due primarily to excessive muscle catabolism. As a well-known inducer of acute inflammation, a lipopolysaccharide (LPS) challenge can cause serious skeletal muscle wasting. However, knowledge of the role of miRNAs in the course of inflammatory muscle catabolism is still very limited. In this study, RNA extracted from the skeletal muscle of pigs injected with LPS or saline was subjected to small RNA deep sequencing. We identified 304 conserved and 114 novel candidate miRNAs in the pig. Of these, four were significantly increased in the LPS-challenged samples and five were decreased. The expression of five miRNAs (ssc-miR-146a-5p, ssc-miR-221-5p, ssc-miR-148b-3p, ssc-miR-215 and ssc-miR-192) were selected for validation by quantitative polymerase chain reaction (qPCR), which found that ssc-miR-146a-5p and ssc-miR-221-5p were significantly upregulated in LPS-challenged pig skeletal muscle. Moreover, we treated mouse C2C12 myotubes with 1000 ng/mL LPS as an acute inflammation cell model. Expression of TNF-α, IL-6, muscle atrophy F-box (MAFbx) and muscle RING finger 1 (MuRF1) mRNA was strongly induced by LPS. Importantly, miR-146a-5p and miR-221-5p also showed markedly increased expression in LPS-treated C2C12 myotubes, suggesting the two miRNAs may be involved in muscle catabolism systems in response to acute inflammation caused by a LPS challenge. To our knowledge, this study is the first to examine miRNA expression profiles in weaned pig skeletal muscle challenged with LPS, and furthers our understanding of miRNA function in the regulation of inflammatory muscle catabolism.

[Systemic necrotizing vasculitis presenting as gangrene combined with diabetes insipidus: a case report].

The male patient reported here presented as gangrene and central diabetes insipidus (CDI), who had characteristics of vasculitis. The patient complained about polydipsia and polyuria half a year ago, and then developed tingling, pain and blackish discoloration of some fingers and toes 3 month ago. He also had Raynaud's phenomenon. After admission, his laboratory examination showed the rise of erythrocyte sedimentation rate, C-reactive protein, immunoglobulin, ß2-glycoprotein I and the activity of rheumatoid factors, lupus anticoagulant test. his pituitary gland showed loss of posterior signal on magnetic resonance imaging. In addition, his vasopressin test was active. However, there was no sufficient evidence to diagnose any specific disease; as a consequence the patient was diagnosed as idiopathic systemic necrotizing vasculitis (SNV). For SNV, the patient was treated with glucocorticoid 40 mg/d and impact therapy of cyclophosphamide 0.4 g every 2 weeks. He also received symptomatic treatment for gangrene and CDI. Cutaneous involvement leading to gangrene was widely reported in SNV, however pituitary involvement in SNV leading to CDI was rare. The prognosis of this patient was poor.

A hemophagocytic lymphohistiocytosis patient initiated with prominent liver dysfunction: a case report.

Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and potentially fatal syndrome that results from inappropriate activation of lymphocytes and macrophages. It is characterized by fever, hepatosplenomegaly, cytopenias, hypertriglyceridemia, hypofibrinogenemia, and pathologic findings of hemo- phagocytosis in the bone marrow or other tissues. We report an adult HLH case admitted to hepatology department.

Hereditary angioedema: A rare cause of recurrent abdominal pain.

Hereditary angioedema is a rare autosomal dominant inherited disease which is characterized by an episodic, self-limiting increase in vascular permeability. Symptoms commonly involve in nonpitting, nonpruritic skin swellings. We present a case of hereditary angioedema. The patinets complained of a recurrent abdominal pain without accompanying skin swelling whose diagnosis was delayed nearly 20 years and accepted an unnecessary surgery. According to the decreased serum C1-inhibitor and C4 concentration, the patient was finally diagnosed with hereditary angioedema type I. After treatment with danazole, the patient reported a significant decrease in the frequency of attacks and the severity of pain. HAE is a rare cause of abdominal pain, however it needs to be taken as one of the differential diagnosis of various acute abdomens in order to avoid unnecessary surgeries.

Effect of adenovirus-mediated PTEN gene on ulcerative colitis-associated colorectal cancer.

PURPOSE: This study investigated the expression pattern of PTEN and its effect on carcinogenesis of ulcerative colitis-associated colorectal cancer, leading to insights into the underlying molecular mechanism. METHODS: We established a mouse model of ulcerative colitis-associated colorectal cancer by treating the animals with azoxymethane (AOM) and dextran sulphate sodium (DSS), and investigated the inflammation-dysplasia-carcinoma sequence. Expression patterns of PTEN, p-Akt and Ki-67 were shown by immunohistochemistry; western blotting techniques were used to detect protein expression of PTEN, p-Akt and caspase 3; TUNEL assay was used to measure apoptosis in colon epithelial cells; and colorimetric analysis was able to determine MPO activity in colon tissues. RESULTS: During the inflammation-dysplasia-carcinoma sequence, PTEN expression gradually decreased, while p-Akt expression increased; PTEN and p-Akt levels were negatively correlated. Compared to the AOM-DSS and Ad-0 groups, Ad-PTEN mice had longer colons, fewer tumours (P < 0.01) and smaller tumour sizes (P < 0.05). After injecting Ad-PTEN, expression of p-Akt, Ki-67 and MPO activity decreased dramatically, whereas PTEN increased. The TUNEL assay showed increased apoptotic cells and caspase 3 expression in the Ad-PTEN group. CONCLUSION: PTEN plays an important role in the inflammation-dysplasia-carcinoma sequence and may be a new molecular target in preventing and treating ulcerative colitis-associated colorectal cancer.

[The clinical characteristics of 151 cases of Budd-Chiari syndrome].

OBJECTIVE: To summarize the clinical features of Budd-Chiari syndrome. METHODS: A total of 151 Budd-Chiari syndrome admitted in Peking University People's Hospital from 1996 to 2012 were analyzed retrospectively. RESULTS: Abdominal distension was the most common complaint, with 62.9% (95/151) of lower extremity edema, 53.0% (80/151) of typical bottom-up flow of the abdominal wall longitudinal varicose veins and 60.9% (92/151) with ascites. Laboratory tests results showed median of alanine aminotransferase (ALT) was 21.5 (15.0, 30.0) U/L, aspartate aminotransferase (AST) was 30.0 (23.8, 42.0) U/L, total bilirubin was 31.1(23.3, 47.8) µmol/L, blood albumin 37.5 was (31.8, 41.5) g/L, prothrombin activity was 71% (61%, 84%). WBC was 5.2 (3.5, 7.5) ×10(9)/L, hemoglobin concentration was 126.5 (108.8, 144.2) g/L, and platelet count was 117.0 (85.5, 155.5)×10(9)/L. Abdominal B-ultrasound examination showed hepatomegaly existed in 68.9% (104/151) patients.Intraoperative angiography and surgical exploration showed that 41.1% (62/151) patients were simple inferior vena cava obstruction or stenosis, 15.9% (24/151) were simple hepatic vein obstruction or stenosis and 43.0% (65/151) suffered from the inferior vena cava combined with hepatic vein stenosis or obstruction.Surgically confirmation of the lesions showed that inferior vena cava membrane-like structure combined with thrombosis was in 59.6% (90/151) cases. CONCLUSIONS: Liver congestion, inferior vena cava congestion and portal hypertension are the main clinical manifestations of Budd-Chiari syndrome.With slightly liver function injury, liver dysfunction of Budd-Chiari syndrome isn't parallel with its portal hypertension.

[The characteristics of gastroesophageal reflux disease overlapping with functional bowel diseases in gastrointestinal clinic].

UNLABELLED: OBJECTIVE To analyze the common symptoms in our gastrointestinal (GI) clinic of a general hospital and the prevalence of gastroesophageal reflux disease (GERD) combined with functional bowel diseases (FBD) was also investigated. METHODS: Data of out-patients who visited GI clinic from April to June, 2011 were collected, including demographic information and chief complaints. A validated Chinese Reflux Disease Questionnaire (RDQ) was used to assess the frequency and severity of typical gastroesophageal reflux (GER) symptoms. Reflux esophagitis (RE) and non-erosive gastroesophageal reflux disease (NERD) were differentiated according to RDQ scores, endoscopic diagnosis, and response to proton pump inhibitors (PPIs). FBD was diagnosed based on Rome III criteria. RESULTS: Totally 1074 patients(98.3%) had completed the questionnaires. A total of 107 patients(10%) were diagnosed as GERD among 351 patients(32.7%) who had GER symptoms. A total of 404 cases (37.6%) presented symptoms of chronic abdominal pain/bloating, chronic diarrhea/constipation. Totally 206 cases (19.2%) of FBD were diagnosed, including 63 irritable bowl disease (IBS), 40 functional constipation and others. RDQ scores were positively correlated with the prevalence of other atypical GER symptoms, as well as chronic bloating, constipation, the incidence of IBS and functional constipation (FC) (P < 0.05). Further, the incidences of chronic bloating [25.2% (27/107)], chronic constipation [14.0% (15/107)], IBS [10.3% (11/107)] and FC[7.5% (8/107)] in GERD patients were higher than those in non-GERD patients [16.6% (160/966), 7.1% (69/966), 5.4% (52/966), 3.3% (32/966), all P < 0.05]. Higher rate of NERD than RE overlapping with FBD was found, but without statistic significance. CONCLUSIONS: GERD frequently represents with chronic bloating and constipation, usually overlaps with IBS and FC. The severity of GERD symptoms is associated with higher rate of overlapping with FBDs.

[Clinical analysis of 20 cases of synchronous multi-primary esophageal carcinomas].

OBJECTIVE: To explore the clinicopathologic findings, endoscopic features and preoperative diagnostic rates of synchronous multi-primary esophageal carcinomas. METHODS: A total of 602 inpatients were diagnosed as esophageal carcinomas from January 1990 to April 2012. According to Warren's criteria, 20 cases of synchronous multi-primary esophageal carcinomas were enrolled. There were 13 males and 7 females with a mean age of (62 ± 11) years at the onset of diagnosis. Clinicopathologic features and diagnostic methods were studied retrospectively. RESULTS: There were a total of 45 synchronous multi-primary esophageal carcinomas. Most lesions occurred in middle and lower thoracic esophagus (40 lesions, 88.9%) and were of fungating type (27 lesions, 60.0%) under endoscopy. Histologically the most common type was squamous cell carcinoma (36 lesions, 80.0%). Eleven cases of upper gastro-enterography (n = 15) and 6 cases of endoscopy (n = 11) were miss-diagnosed respectively. CONCLUSIONS: Because of a high rate of missed diagnosis, a clinician should be aware of multi-esophageal carcinomas. It is important to perform upper gastro-enterography, abdominal computed tomography and endoscopy conscientiously to improve the diagnosis.

[Typical symptoms of colorectal cancer and its influence in timely diagnosis].

OBJECTIVE: To explore the spectrum of typical symptoms associated with colorectal cancer (CRC) and their influence in timely diagnosis. METHODS: A total of 400 cases were randomly collected from 1798 CRC patients treated at our hospital from January 2000 to December 2010. A retrospective chart review was undertaken for all identified cases. Besides demographics and tumor features, TNM stage was obtained from medical records and pathological forms. Other relevant data were as follows: (1) initial symptom complex, (2) presenting symptom or symptom complex, (3) patient duration: period from initial symptoms to consulting a doctor, (4) hospitalization duration: period from initial seeing a doctor to a confirmed CRC case, (5) diagnostic duration: patient duration plus hospitalization duration, (6) rate of misdiagnosis: CRC subjects being diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis. χ(2) tests were used to compare the differences of rates of kinds of symptoms and early diagnosis. RESULTS: Among 400 study subjects, the frequencies of initial symptoms in a decreasing order were change in bowl habits (170, 42.5%), abdominal pain and/or discomfort (157, 39.3%), rectal bleeding (147, 36.8%) and anorectal stimulating symptoms (69, 17.3%). And 176 cases (44.0%) presented multiple symptoms. Short-term health care seeking (≤ 15 d) after initial symptoms was 40.7% (159/391) within all cases, but only 25.3% (42/166) cases with symptoms of change in bowel habits saw a doctor. The rate was significantly lower than that of other cases (117/225, 52.0%, P = 0.000) without this symptom. An onset of symptom complex did not lead to short-term health seeking compare to individual symptoms. Above 50% cases were already in late stage (TNM stage later than IIb) as any of the above initial symptoms appeared. No differences of pathology and differentiate of tumors were found among cases with different initial symptoms (P > 0.05). Further analyzed the consulting symptoms: rectal bleeding 179 frequency (44.8%), abdominal pain or discomfort 159 frequency (39.8%), change in bowl habits 155 frequency (38.8%), and Anal rectum stimulating symptoms 69 frequency (17.3%). 50.8% (203 cases) consulted a doctor with multiple symptoms. 59.9% (236/394) cases were of short term hospitalization duration (≤ 15 d). However, only 52.5% (83/158) in cases whose consulting symptoms included abdominal pain or discomfort, lower than that in other cases without these symptoms (64.8%, 153/236) (P < 0.05). High rate of misdiagnosis (50.0%, 10/20) was found in Melena consulter than others (26.8%, 101/377, P < 0.05). CONCLUSIONS: Change in bowel habits, rectal bleeding and abdominal pain are the most common symptoms in CRC. And consulting and initial symptoms are similar. Diagnostic and hospitalization delays are seen in half of CRC cases.

A Deep Learning Algorithm for Detecting Acute Pericarditis by Electrocardiogram.

(1) Background: Acute pericarditis is often confused with ST-segment elevation myocardial infarction (STEMI) among patients presenting with acute chest pain in the emergency department (ED). Since a deep learning model (DLM) has been validated to accurately identify STEMI cases via 12-lead electrocardiogram (ECG), this study aimed to develop another DLM for the detection of acute pericarditis in the ED. (2) Methods: This study included 128 ECGs from patients with acute pericarditis and 66,633 ECGs from patients visiting the ED between 1 January 2010 and 31 December 2020. The ECGs were randomly allocated based on patients to the training, tuning, and validation sets, at a 3:1:1 ratio. We used raw ECG signals to train a pericarditis-DLM and used traditional ECG features to train a machine learning model. A human-machine competition was conducted using a subset of the validation set, and the performance of the Philips automatic algorithm was also compared. STEMI cases in the validation set were extracted to analyze the DLM ability of differential diagnosis between acute pericarditis and STEMI using ECG. We also followed the hospitalization events in non-pericarditis cases to explore the meaning of false-positive predictions. (3) Results: The pericarditis-DLM exceeded the performance of all participating human experts and algorithms based on traditional ECG features in the human-machine competition. In the validation set, the pericarditis-DLM could detect acute pericarditis with an area under the receiver operating characteristic curve (AUC) of 0.954, a sensitivity of 78.9%, and a specificity of 97.7%. However, our pericarditis-DLM also misinterpreted 10.2% of STEMI ECGs as pericarditis cases. Therefore, we generated an integrating strategy combining pericarditis-DLM and a previously developed STEMI-DLM, which provided a sensitivity of 73.7% and specificity of 99.4%, to identify acute pericarditis in patients with chest pains. Compared to the true-negative cases, patients with false-positive results using this strategy were associated with higher risk of hospitalization within 3 days due to cardiac disorders (hazard ratio (HR): 8.09; 95% confidence interval (CI): 3.99 to 16.39). (4) Conclusions: The AI-enhanced algorithm may be a powerful tool to assist clinicians in the early detection of acute pericarditis and differentiate it from STEMI using 12-lead ECGs.

[Symptom-based relationship between gastroesophageal reflux disease and laryngopharyngeal reflux disease].

OBJECTIVE: To explore the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) based on symptoms. METHODS: A total of 1090 patients undergoing upper digestive tract motility test were invited to complete the surveys of reflux disease questionnaire and reflux symptom index from August 2007 to October 2010. And 895 responders provided valid answers. There were 474 females and 421 males. RESULTS: Among 895 responders, 351 patients had neither, 218 suffered both conditions, 237 were diagnosed as GERD alone and 89 LPRD alone. No difference was found in age (P = 0.383)or gender ratio (P = 0.227). In 455 GERD patients, there were 218 LPRD cases (47.9%). In 307 LPRD patients, 218 (71.0%) had concurrent GERD. In GERD patients, the frequency and degree of feeling of stomach content reflux into mouth were correlated with RSI (r = 0.115, 0.141, P = 0.007, 0.001). CONCLUSION: GERD and LPRD may coexist or occur alone. Because of a high concurrent ratio of LPRD in GERD, the treatment strategy of GERD should be modified accordingly. In GERD patients, the feeling of stomach content reflux into mouth may suggest a possibility of LPRD.

[Influences of diagnostic modes on an early diagnosis of colorectal cancer].

OBJECTIVE: To explore the influences of diagnostic modes of colorectal cancer (CRC) on an early diagnosis of CRC. METHODS: A total of 405 cases were randomly collected from 1798 CRC patients registered at our hospital from January 2000 to December 2010. A retrospective chart review was undertaken for all identified cases. Besides the demographics and tumor features, TNM stage was obtained from medical records and pathological forms. Other collected data were as follows: (1) Type of clinical examinations leading to diagnosis. (2) Diagnostic duration: including patient duration (period from initial symptoms to consulting a doctor and hospitalization duration (period from patient first seeing a doctor to a confirmed CRC case). (3) Diagnostic delay and its rate: diagnostic delay was identified as the diagnostic duration of over 30 days. We compared the different delay periods of 31 - 60, 61 - 90, 91 - 150 and > 150 days and its corresponding tumor stages at diagnosis. (4) Misdiagnosis and its rate: that CRC subjects were diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis. The t and Mann-Whitney U tests were performed for the quantitative data and χ(2) test for the qualitative data. RESULTS: Among the study subjects, 67.2% (270/402) CRC cases were examined by colonoscopy, 17.4 % (70/402) cases by CT scan or B ultrasound. The median diagnostic duration of CRC was 90 days (25% percentile: 40 days, 75% percentile: 210 days). The median patient duration was 30 days and median hospital duration 10 days. The overall misdiagnostic rate of CRC was 27.9% (112/401), higher (39.7%, 48/121) in right sited CRC than in left sited CRC (22.9%, 63/275) (χ(2) = 11.7, P = 0.00). 77.7% (313/403) cases had > 30 days diagnostic delay, 50.8% (156/307) delay attributable to the patients, while 29.0% (89/307) attributable to hospitals and 20.2% (62/307) attributable to both. The diagnostic duration of early-stage CRC and advanced-stage CRC appeared to be in the same length. On the other hand, no difference of TNM stage at the initial diagnosis was found in groups with different diagnostic durations of 31 - 60, 61 - 90, 91 - 150 and > 150 days (all P > 0.05). CONCLUSION: Colonoscopy is the most effective in the diagnosis of CRC. The median diagnostic time of CRC is 90 days. The phenomenon of its diagnostic delay often occurs. However, the delay is not a major cause for its advanced stage and a poor outcome. Its inherent biological characteristics may be more important.