Management of an Esophago-pleural Fistula after Emergent Endoscopic Variceal Injectional Sclerotherapy: A Case Report And Literature Review.

A 48-year-old man developed sudden-onset haematemesis and melena after decompensated posthepatitic cirrhosis. Endoscopic variceal injectional sclerotherapy was emergently performed. However, the patient developed esophago-pleural fistula, empyema, and liver failure. He thus received symptomatic treatments and nasojejunal feedings, which failed to restore the nutrition as the gastroesophageal reflux exacerbated the hydrothorax. Percutaneous endoscopic gastro-jejunal (PEG-J) was therefore carefully performed for enteral nutrition support. The patient had recovered from the fistula at a six-month follow-up, which allowed the resumption of an oral diet. Our literature review revealed that PEG-J is a feasible approach to treating esophago-pleural fistula, a rare but lethal complication of endoscopic sclerotherapy.

Can China reach the CO2 peak by 2030? A forecast perspective.

With the continuous emission of greenhouse gases, climate issues such as global warming have attracted widespread attention. As the largest CO2 emitter, China proposes the target of reaching the CO2 emissions peak by 2030 at the 75th United Nations General Assembly. To determine whether China can realize the goal, we construct an assessment system consisting of a new discrete grey prediction model on the basis of a rolling mechanism and an improved IPCC method. First, the new grey prediction model is used to predict the CO2 emissions and GDP from 2021 to 2030, and then, the enhanced IPCC method is used to obtain the carbon intensity from 2021 to 2030. In line with the direct judgment based on CO2 emissions and the indirect judgment based on the comparison between the AADR of carbon intensity and the AAIR of GDP, we find that China faces great challenges and difficulties in achieving its carbon peaking target by 2030. Finally, based on the forecast data and China's current situation, some policy recommendations are put forward to accelerate China's CO2 peak goal.

The role of circular RNA hsa_circ_0001789 as a diagnostic biomarker in gastric carcinoma.

BACKGROUND: Circular RNA (circRNA) is a kind of endogenous non-coding RNAs and has shown diagnostic values in various cancers. This study aimed to explore whether hsa_circ_0001789 could be a novel biomarker for gastric cancer (GC). METHODS: Quantitative reverse transcriptase PCR was used to detect the expression of hsa_circ_0001789 in 108 paired GC and paracancerous tissues as well as in 24 paired plasma specimens. Possible associations between hsa_circ_0001789 expression and clinicopathologic factors of GC patients were examined using one-way ANOVA. A receiver operating characteristic (ROC) curve was established to investigate the diagnostic value of hsa_circ_0001789 in GC. RESULTS: GC tissues and plasma samples showed down-regulated hsa_circ_0001789 levels than their counterparts, which were closely correlated with the malignant characteristics of GC. The area under the ROC curve (AUC) of hsa_circ_0001789 in GC tissues was 0.82, while the cut-off value was 9.5, indicating a favorable diagnostic value. Compared with the traditional tumor biomarkers, hsa_circ_0001789 had preferred AUCs that reached 0.786 for predicting the stage of invasion, 0.603 for predicting the stage of lymphatic metastasis, 0.722 for predicting the stage of distant metastasis, and 0.786 for predicting TNM stage. CONCLUSIONS: Hsa_circ_0001789 may be a novel biomarker for the diagnosis of gastric carcinoma.

Liver test abnormalities in asymptomatic and mild COVID-19 patients and their association with viral shedding time.

BACKGROUND: Asymptomatic infections and mild symptoms are common in patients infected with the Omicron variant, and data on liver test abnormalities are rare. AIM: To evaluated the clinical characteristics of asymptomatic and mild coronavirus disease 2019 (COVID-19) patients with abnormal liver test results. METHODS: This retrospective study included 661 laboratory-confirmed asymptomatic and mild COVID-19 patients who were treated in two makeshift hospitals in Ningbo from April 5, 2022 to April 29, 2022. Clinical information and viral shedding time were collected, and univariate and multivariate logistic regression models were performed in statistical analyses. RESULTS: Of the 661 patients, 83 (12.6%) had liver test abnormalities, and 6 (0.9%) had liver injuries. Abnormal liver tests revealed a reliable correlation with a history of liver disease (P < 0.001) and a potential correlation with male sex and obesity (P < 0.05). Elevated alanine aminotransferase was reliably associated with obesity (P < 0.05) and a history of liver disease (P < 0.001). Elevated aspartate transaminase (AST) was reliably correlated with a history of liver disease (P < 0.001), and potentially correlated with age over 30 years (P < 0.05). There was a reliable correlation between AST ≥ 2× the upper limit of normal and a longer viral shedding time, especially in mild cases. CONCLUSION: Obesity and a history of liver disease are risk factors for liver test abnormalities. Being male and an older age are potential risk factors. Attention should be given to liver tests in asymptomatic and mild COVID-19 patients, which has crucial clinical significance for evaluating the viral shedding time.

Face-to-Face Instruction and Personalized Regimens Improve the Quality of Inpatient Bowel Preparation for Colonoscopy.

BACKGROUND: Poor bowel preparation is commonly observed in inpatients undergoing colonoscopy, particularly those with higher risks for inadequate bowel preparation. AIMS: The objective of this study was to determine whether personalized bowel preparation regimens combined with face-to-face instruction (FFI) could improve the quality of bowel preparation for inpatient. METHODS: In this endoscopist-blinded, randomized controlled trial, 320 inpatients were enrolled and randomly allocated (1:1) to the control and intervention groups. The intervention group received FFI and personalized bowel preparation regimens, while the control group received the routine bowel preparation regimen and education. The primary outcome was adequate bowel preparation rate. Secondary outcomes included rates of procedure-related adverse events, incorrect diet restriction and laxative intake, etc. RESULTS: The adequate bowel preparation rate in the intervention group was significantly higher compared to control group [intention-to-treat (ITT) analysis: 70.0% vs 51.3%, P < 0.001; per-protocol (PP) analysis: 79.4% vs 58.6%, P < 0.001]. Bowel cleanliness was significantly improved in high-risk inpatients (ITT analysis: 65% vs 44.6%, P = 0.004; PP analysis: 73.0% vs 51.7%, P = 0.004) and in low-risk inpatients (ITT analysis: 80% vs 62.7%, P = 0.037; PP analysis: 92.3% vs 69.8%, P = 0.003). There were no significant differences between two groups regarding procedure-related adverse events. CONCLUSIONS: Personalized bowel preparation regimens combined with FFI improve the rate of adequate bowel preparation, especially for patients with high-risk factors. As such, inpatients could benefit from this novel approach for better bowel preparation to ultimately improve the quality of colonoscopies.

Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: A systematic review and pooled analysis.

BACKGROUND: We performed a systematic review and pooled analysis to assess the effectiveness and safety of different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps. METHODS: Articles in PubMed, EMBASE, and the Cochrane Library related to the common endoscopic treatment of 10- to 20-mm nonpedunculated polyps published as of April 2020 were searched. Primary outcomes were the R0 resection rate and en bloc resection rate. Secondary outcomes were safety and the recurrence rate. Meta-regression and subgroup analysis were also performed. RESULTS: A total of 36 studies involving 3212 polyps were included in the final analysis. Overall, the effectiveness of resection methods with a submucosal uplifting effect, including endoscopic mucosal resection (EMR), cold EMR and underwater EMR (UEMR), was better than that of methods without a nonsubmucosal uplifting effect [R0 resection rate, 90% (95% confidence interval (CI) 0.81-0.94, I2 = 84%) vs 82% (95% CI 0.78-0.85, I2 = 0%); en bloc resection rate 85% (95% CI 0.79-0.91, I2 = 83%) vs 74% (95% CI 0.47-0.94, I2 = 94%)]. Regarding safety, the pooled data showed that hot resection [hot snare polypectomy, UEMR and EMR] had a higher risk of intraprocedural bleeding than cold resection [3% (95% CI 0.01-0.05, I2 = 68%) vs 0% (95% CI 0-0.01, I2 = 0%)], while the incidences of delayed bleeding, perforation and post-polypectomy syndrome were all low. CONCLUSIONS: Methods with submucosal uplifting effects are more effective than those without for resecting 10- to 20-mm nonpedunculated colorectal polyps, and cold EMR is associated with a lower risk of intraprocedural bleeding than other methods. Additional research is needed to verify the advantages of these methods, especially cold EMR.

Impact of second forward-view examination on adenoma detection rate during unsedated colonoscopy: a randomized controlled trial.

OBJECTIVES: Colorectal cancer on the right side of the colon has been suggested to be harder to detect by colonoscopy. The aim of this study was to evaluate whether a second forward-view examination of the right side of the colon could increase the adenoma detection rate (ADR) and/or polyp detection rate (PDR). METHODS: This was a single-centre randomized controlled trial. Patients undergoing colonoscopy were recruited and randomly assigned to the second forward-view examination (SFE) group, in which the right side of the colon was examined twice or the traditional colonoscopy (TC) group in which the colonoscopy was performed in a standard manner. The primary outcome was the ADR of right colon. The overall PDR and ADR, PDR of the right colon, per-adenoma miss rate of the right colon, and advanced lesion detection rate were also recorded and compared. RESULTS: A total of 392 patients were included in the study (SFE group 197 vs. TC group 195). The ADR and PDR of the right colon in the SFE group were significantly higher than those in the TC group (ADR 10.7% vs. 5.1%; P = 0.042); PDR 17.8% vs. 9.7%, P = 0.021). No significant difference was found in overall PDR/ADR, or advanced lesion detection rate between the two groups. CONCLUSIONS: This prospective controlled study revealed that a second forward-view examination could modestly increase the ADR and PDR of the right colon during unsedated colonoscopies. This simple, safe and time-effective technique might be recommended for routine unsedated colonoscopy. TRIAL REGISTRATION: Clinical Trials.gov, NCT03619122. Registered on 7/8/2018.

Validity of the Use of Wrist and Forehead Temperatures in Screening the General Population for COVID-19: A Prospective Real-World Study.

BACKGROUND: We aimed to compare the accuracy of individuals' wrist and forehead temperatures with their tympanic temperature under different circumstances. METHODS: We performed a prospective observational study in a real-life population in Ningbo First Hospital in China. We consecutively recorded individuals' wrist and forehead temperatures in Celsius (°C) using a non-contact infrared thermometer (NCIT). We also measured individuals' tympanic temperature using a tympanic thermometer (IRTT) and defined fever as a tympanic temperature of ≥37.3 °C. RESULTS: We enrolled 528 participants, including 261 indoor and 267 outdoor participants. We grouped the outdoor participants into four groups according to their means of transportation to the hospital: by foot, by bicycle/electric vehicle, by car, or as a passenger in a car. Under different circumstances, the mean difference in the forehead measurement ranged from -1.72 to -0.56 °C across groups, and that in the wrist measurement ranged from -0.96 to -0.61°C. Both measurements had high fever screening abilities in indoor patients. (Wrist: AUC 0.790; 95% CI: 0.725-0.854, P<0.001; forehead: AUC 0.816; 95% CI: 0.757-0.876, P <0.001). The cut-off value of the wrist measurement for detecting a tympanic temperature of ≥37.3 °C was 36.2 °C, with 86.4% sensitivity and 67.0% specificity, and the best threshold for the forehead measurement was 36.2 °C, with 93.2% sensitivity and 60.0% specificity. CONCLUSION: Wrist measurements are more stable than forehead measurements under different circumstances. Both measurements have favorable fever screening abilities in indoor patients. The cut-off values were both 36.2 °C.