Gastrointestinal symptoms as a common clinical evaluation index require a universal evaluation tool, and the Gastrointestinal Symptom Rating Scale (GSRS) has been widely applicated in domestic studies. However, the versions used are not standardized Chinese versions and their measurement performance has not been reported yet.

To explore the measurement performance of the Chinese version of the GSRS, in order to provide an objective basis for expanding the application of the scale.

From October 2021 to March 2022, patients with irritable bowel syndrome (IBS), chronic enteritis and chronic gastritis who attended outpatient clinics of splenogastroenterology or gastroenterology in 45 hospitals (community health service centers), including Jilin Provincial People's Hospital and Beijing Changping District Urban Community Health Service Center, etc. The Chinese version of GSRS was used to evaluate the gastrointestinal symptoms of the included patients on treatment days 0, 3, 7 and 14. Reliability and validity analyses were conducted on the Chinese version of GSRS, and the paired Wilcoxon signed rank sum test was applied to compare the changes in the scores of patients before and after treatment. Additionally, effect size (ES), standardized response mean (SRM), and score change rate (CR) were used to assess the responsiveness of the scales.

A total of 554 patients were included and followed up, including 127 patients (22.93%) with IBS, 244 (44.04%) patientswith chronic enteritis and 183 (33.03%) patients with chronic gastritis. The Cronbach's alpha coefficient for the Chinese version of GSRS was 0.896, the Guttman Split-half coefficient was 0.920, the Spearman-Brown coefficient was 0.926, the intraclass correlation coefficient (ICC) for the two retest results was 0.589, and the Spearman correlation coefficient was 0.662. The content validity index for each item ranged from 0.78 to 1.00. The content validity index (CVI) for the scale-level universal agreement was 0.73, and the average CVI was 0.96. Exploratory factor analysis extracted a total of three common factors with eigenvalues>1, and the rate of cumulative variance contribution is 60.721%.The validation factor analysis demonstrated that the data samples did not fit the initial model M0 well, and each fit index of model M1 is within the acceptable range after correction according to the modification indicator hints in the acceptable range: χ²/df<3.000, root mean square error of approximation (RMSEA) <0.800, and each fit index >0.900. The total Chinese version of GSRS scores of patients after 14 d of treatment are lower than the total Chinese version of GSRS scores before treatment (P<0.001), with ES=1.03, SRM=1.01, and CR=74.32%.

The Chinese version of GSRS has a high level of measurement performance with good reliability and responsiveness, which is suitable for measuring a general population with gastrointestinal symptoms and evaluating the treatment effectiveness of them.

Chronic atrophic gastritis (CAG) with intestinal metaplasia (IM) is an independent risk factor for gastric cancer. Long-term inflammation and oxidative stress response stimulate the physical and mental state of patients. Under the modern medical model, proton pump inhibitors and gastric mucosal protective agents are increasingly unable to meet the high drug resistance of patients. It is urgent to seek effective new Chinese medicine treatments and multiple methods to treat CAG and IM.

To evaluate the clinical efficacy and safety of modified Piwei Peiyuan Decoction combined with acupuncture in the treatment of CAG with IM.

From January 2022 to September 2023, 202 patients with CAG and IM diagnosed by gastroscopy and pathological examination in the Department of Spleen and Stomach, the Center for Preventive Treatment of Disease, the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine and the Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine were selected. The patients were divided into control group (n=67), treatment group A (n=68) and treatment group B (n=67) by random number table method. All patients participated in 6 weeks of treatment: (1) Control group: aluminum magnesium suspension combined with folic acid tablets (3 times/d) ; (2) Treatment group A: to add and subtract syndrome types of Piwei Peiyuan Decoction (2 times/d) ; (3) Treatment group B: Piwei Peiyuan Decoction (the same as group A) combined with acupuncture (1 time/d), with Zusanli, Liangqiu, Gongsun, Neiguan, Zhongwan as the main points, according to the syndrome type selection of acupoints. Before and 6 weeks after treatment, OLGA, OLGIM staging, gastric mucosal pathological efficacy, gastric mucosal pathological score, clinical symptom score, PRO scale score, drug-related adverse events (AE) and adverse drug reactions (ADR) were recorded.

A total of 192 patients completed the 6-week course of treatment (62 in the control group, 66 in the treatment group A, and 64 in the treatment group B). The effective rate of the control group was 48.39% (30/62), the effective rate of the treatment group A was 69.70% (46/66), and the effective rate of the treatment group B was 71.88% (46/64). There was a statistically significant difference in the effective rate among the three groups (χ²=9.144, P=0.01). After treatment, the gastric mucosal pathological score, clinical symptom score and PRO scale score in the three groups were lower than those in the same group before treatment (P<0.05). Pathological score of gastric mucosa: the scores of chronic inflammation, atrophy and IM in treatment group A and treatment group B were lower than those in control group, and the scores of active inflammation and dysplasia were higher than those in control group (P<0.05). Clinical symptom score: the scores of epigastric fullness and epigastric pain in treatment group A and treatment group B were lower than those in control group (P<0.05). The PRO scale score: the treatment group A and the treatment group B were lower than the control group in acid reflux, dyspepsia, defecation, psychological state, systemic symptoms and total score (P<0.05). There was no significant difference in the incidence of AE and ADR among the three groups (P>0.05) .

The overall clinical efficacy of Piwei Peiyuan Decoction combined with acupuncture is better than that of aluminum magnesium suspension combined with folic acid tablets, which is better than that of traditional antacids and gastric mucosal protective agents.

Inflammatory bowel disease (IBD) has become highly prevalent in recent years characterized by a prolonged disease course and high disease burden. However, there is a lack of data to understand the burden of IBD in China, which may hinder health care planning and resource allocation for the disease.

To investigate the burden of IBD and its variation tendency in China from 1990 to 2019, and analyze the influence of age, gender and period on IBD.

The incidence, mortality and disability adjusted life year (DALY) rate of IBD in China from 1990 to 2019 were collected using the Global Burden of Disease Database 2019. Joinpoint software was used to analyze the variation tendency and characteristics of standardized incidence, standardized mortality and standardized DALY rate of IBD, and Excel 2019 software was used for data processing.

From 1990 to 2019, the standardized incidence increased from 1.47/100 000 to 3.01/100 000 with avevage annual percent change (AAPC) of 2.50%〔95%CI (2.4%, 2.6%) 〕, the standardized mortality decreased from 0.86/100 000 to 0.35/100 000 with AAPC of -1.6%〔95%CI (-3.8%, -3.4%) 〕, the standardized DALY rate decreased from 24.47/100 000 to 16.31/100 000, with AAPC of -2.2%〔95%CI (-2.3%, -2.0%) 〕, the changes of trends were all statistically significant (P<0.05) . The standardized incidence and mortalityof of males were higher than females in each year, while the standardized DALY rate of females was higher than males before 1995, basically the same in males and females from 1995 to 2001, and higher in males than females after 2001. There was overall stable uptrend in the AAPC of the standardized incidence of IBD in all age groups by year (P<0.05) and overall downtrend in the AAPC of standardized mortality rate in all age groups, while the downtrend became slower with increasing age (P<0.05) .

From 1990 to 2019, the standardized mortality rate and DALY rate of IBD showed a downtrend, while the standardized incidence showed an uptrend. The standardized incidence and mortality of males were higher than females by year. The burden of IBD in elderly population deserves priority attention and will be a major public health challenge in China due to large population base and aging population.

Primary liver cancer is one of the common cancers in the world and with extremely high morbidity and mortality. This paper details the current epidemiology of primary liver cancer, population attributable fractions and associated risk factors in China. In this paper, we found that hepatitis B virus and hepatitis C virus are still the main risk factors for the development of primary liver cancer by searching the databases such as PubMed, Web of Science, and CNKI. With hepatitis B virus vaccination and antiviral treatment, the incidence of primary liver cancer in China has slightly decreased, but the incidence of primary liver cancer caused by metabolic factors such as diabetes, obesity and non-alcoholic fatty liver disease is gradually increasing; smoking and alcohol consumption are also important risk factors. This article summarizes the epidemiological characteristics and risk factors of primary liver cancer, which can provide practical evidence-based medicine evidence for the development of preventive and control measures for primary liver cancer.

Locally advanced gastric cancer mainly includes stage Ⅲ gastric cancer, which is mainly treated with comprehensive therapy. Postoperative recurrence is a key factor affecting the prognosis of patients.

To explore the influencing factors of long-term prognosis in patients with stage Ⅲ gastric cancer undergoing D2 radical surgery and adjuvant chemotherapy.

Gastric cancer patients who underwent D2 radical surgery and adjuvant chemoradiotherapy were collected from the Department of Radiotherapy at Zhongshan Hospital affiliated to Fudan University from 2009 to 2014. They were pathologically diagnosed with stage Ⅲ gastric cancer according to the International Union of Cancer (UICC) and American Cancer Federation (AJCC) 8th edition TNM staging system for gastric cancer. All postoperative patients were followed up every 3 months in the first year, every 6 months for the following 2 years, and once a year thereafter. The deadline for follow-up is December 15, 2021. Survival rates of subgroups were compared using Log-rank tests.The influencing factors of overall survival (OS) and disease-free survival (DFS) were compared using Cox proportional hazards regression analysis, and the prediction of clinicopathological features were analyzed by Nomogram. Comparison of survival differences among patients with different pTNM stagings, age, metastatic lymph node radios (LNR), and gastrectomy methods using Kaplan-Meier method.

A total of 135 qualified patients were included, with a median follow-up time of 10.48 years. Within 5 years, there were 70 cases of recurrence and 62 deaths. The 5-year DFS rate and OS rate were 48.1% (65/135) and 54.1% (73/135), respectively; Within 10 years, there were 74 cases of recurrence and 74 deaths. The 10-year DFS rate nd OS rate were both 45.2% (61/135). The Log-rank test results showed that there was a statistically significant difference in 5-year survival rates among patients with different pTNM stagings, pT stagings, LNRs, cancer nodules, tumor locations, and gastrectomy methods (P<0.05). The 10-year survival rates of patients with different pTNM stagings, pT stagings, LNRs, nerve infiltrations, and gastrectomy methods were compared, and the differences were statistically significant (P<0.05). The results of multivariate Cox proportional hazards regression analysis showed that pTNM staging (Stage ⅢA, OS: HR=0.40, 95%CI=0.19-0.83; DFS: HR=0.40, 95%CI=0.19-0.92), LNR (>50%, OS: HR=1.74, 95%CI=1.03-2.94; DFS: HR=1.73, 95%CI=1.02-2.94), and gastrectomy method (total gastrectomy, OS: HR=2.07, 95%CI=1.22-3.50; DFS: HR=2.02, 95%CI=1.20-3.41) were independent influencing factors for OS and DFS in patients with stageⅢ gastric cancer undergoing D2 radical surgery with adjuvant chemotherapy (P<0.05), while age (≤ 40 years, HR=2.19, 95%CI=1.06-4.53) was an independent influencing factor for OS. Moreover, nomogram indicated that age, pTNM staging, LNR, and gastrectomy method have good predictive effects on the prognosis. For recurrence, 10 cases (7.4%) experienced local recurrence (recurrence of anastomotic sites and lymph nodes within the radiation field), 35 cases (25.9%) experienced abdominal and pelvic dissemination of implants, and 37 cases (27.4%) experienced distant metastasis (including lung, liver, bone, brain and other organs) ; Some patients had two or more types of recurrence. The postoperative survival curves of stageⅢ gastric cancer patients with different pTNM stagings, age, LNRs, and gastrectomy methods were compared, and the differences were statistically significant (P<0.05) .

Most patients with stageⅢ gastric cancer who undergo adjuvant chemoradiotherapy after D2 radical surgery experience recurrence or death within 5 years. pTNM staging, LNR, and gastrectomy method are factors that affect the prognosis of these patients.

The incidence of colorectal cancer is high, and metastatic colorectal cancer has entered a new era of targeted immunotherapy. Due to the limited choices of effective later-line treatment and the substantial reduction of physical quality caused by long-term treatment of patients who have experienced more than three lines of treatment, the choice of later-line treatment with less adverse reactions and better clinical effect needs to be further explored.

To observe the clinical effect and safety of fruquintinib plus programmed death receptor-1 (PD-1) inhibitors in the third-line and above treatment of mCRC.

The clinical data of 75 patients with metastatic colorectal cancer admitted in the First Affiliated Hospital of Zhengzhou University from June 2020 to March 2022 were collected and analyzed retrospectively. The patients were divided into the fruquintinib alone group (n=28) and the PD-1 inhibitor plus fruquintinib group (n=47). The treatment regimen was: the patients in the fuquitinib alone group took oral furoquitinib capsules at 5 mg/d once for 3 consecutive weeks with a 1-week stop in 28-day cycles, the patients in the PD-1 inhibitor plus fruquintinib group were injected intravenously with carrilizumab/sindilizumab/pabrolizumab 200 mg and treprolizumab 240 mg from the first day in 21-day cycles, and fruquintinib was used in the same way as the fruquintinib alone group. The main observation indexes were objective response rate (ORR), disease control rate (DCR), progression-free survival time (PFS) and incidence of adverse reactions in the two groups.

As of the last follow-up (2022-05-31), the ORR of the fruquintinib alone group and the PD-1 inhibitor plus fruquintinib group were 7.1% and 14.9%, the DCR of the fruquintinib alone group and the PD-1 inhibitor plus fruquintinib group were 67.9% and 89.4%, the DCR of patients in the PD-1 inhibitor plus fruquintinib group was significantly higher than that in the furoquinitinib alone group (χ²=5.345, P=0.021). The median PFS of the PD-1 inhibitor plus fruquintinib group and fruquintinib alone group were 6.4 months (IQR: 4.0-13.1) and 4.5 months (IQR: 2.9-8.2) ; there was significant difference in PFS between the two groups (χ²=5.504, P=0.019). Most of the adverse reactions during the treatment of the two groups were grade 1-2. The incidence of hypothyroidism in the PD-1 inhibitor plus fruquintinib group was significantly higher than that in the fruquintinib alone group (P<0.05). In addition, there was no significant difference in the incidence of other adverse reactions between the two groups (P>0.05) .

Compared with fruquintinib alone, PD-1 inhibitor plus fruquintinib has prolonged survival time and reduced incidence of severe adverse reactions in patients with metastatic colorectal cancer, making it an effective and safe treatment.

Non-alcoholic fatty liver disease has showed a high prevalence and a increasing trend especially towards younger age. It is of great public health significance to reduce damage through early detection of NAFLD in physical examination and intervention in time.

To investigate the detection rate of NAFLD in the Beijing physical examination population from 2018 to 2021, and analyze its related influencing factors.

People who received physical examinations at the Beijing Physical Examination Center from 2018-01-01 to 2021-12-31 were selected based on the inclusion criteria, the results of physical examination, laboratory examination, and liver ultrasonography were collected for analysis. Univariate analysis was performed using t-test, Mann-Whitney U test and Chi-square test. Multivariate Logistic regression was used to explore the influencing factors of NAFLD.

A total 325 726 people were included in the study, of which 108 512 cases of NAFLD were detected, with a detection rate of 33.31%. The results of liver ultrasonography revealed that the number of mild, moderate and severe NAFLD detections were 74 062, 33 281 and 1 169 cases, accounting for 68.25%, 30.67% and 1.08% of the detection population, respectively. The detection rate of NAFLD was higher in males than females (χ²=17 518.893, P<0.05). Chi-square test for trend revealed an age-dependent increase detection rate of NAFLD before 70 years old, and a subsequent decline after reaching 70 years old (χ^2trend=14 397.61, P<0.001). Higher detection rate was revealed in males than females among people aged 18-59 years (P<0.05), while lower detection rate in males than females among people aged ≥70 years old (P<0.05). Multivariate Logistic regression results showed that gender (male: OR=1.173), aging (30-39: OR=1.604, 40-49: OR=1.948, 50-59: OR=2.486, 60-69: OR=2.663, 70-79: OR=2.079, ≥80: OR=1.149), BMI (18.5-23.9 kg/m²: OR=2.997, 24.0-27.9 kg/m²: OR=3.911, ≥28.0 kg/m²: OR=11.780), systolic blood pressure (SBP) (≥140 mmHg: OR=1.200), diastolic blood pressure (DBP) (≥90 mmHg: OR=1.177), fasting blood glucose (FBG) (≥6.10 mmol/L: OR=1.934), triacylglycerol (TG) (≥1.70 mmol/L: OR=2.946), total cholesterol (TC) (≥5.20 mmol/L: OR=1.050), high-density lipoprotein cholesterol (HDL-C) (<1.0 mmol/L: OR=1.645), low-density lipoprotein cholesterol (LDL-C) (≥3.4 mmol/L: OR=1.499), serum uric acid (SUA) (SUA_male>420 μmol/L, SUA_female>360 μmol/L: OR=2.067) were influencing factors for NAFLD (P<0.05) .

The detection rate of NAFLD in physical examination population in Beijing was 33.31%, the highest incidence showed in people aged 50 to 69 years. Males, overweight and obese people are the high-risk groups, and abnormalities in blood lipids, blood pressure and blood glucose are also risk factors for NAFLD.

Esophageal and gastric varices bleeding (EGVB) is one of the most common and dangerous complications of liver cirrhosis. However, whether EGVB affects the one-year mortality of patients with liver cirrhosis remains unclear.

To explore the influence of EGVB on one-year mortality and influencing factors in patients with liver cirrhosis, providing guidance for follow-up for these patients.

This study selected liver cirrhosis patients who were admitted to the Affiliated Changsha Central Hospital, University of South China from January 2015 to May 2021. The patients were divided into EGVB group and non-bleeding (control group) by the prevalence of EGVB at the first consultation. One-year routine follow-up was conducted with them until the date of death from liver cirrhosis or the termination follow-up day. Logistic regression analysis was conducted for screening the factors affecting one-year mortality. Furthermore, the covariates between the two groups were matched in a 1∶2 ratio using propensity score matching (PSM) . Then, Logistic regression analyses were applied to identify and compare the influencing factors of one-year mortality in the groups.

Among the 812 patients enrolled, 158 (19.5%) were diagnosed with EGVB, and the other 654 (80.5%) had no EGVB. The one-year mortality of the EGVB and control groups was 13.3% (21/158) and 13.9% (91/654) , respectively, showing no significant difference (P>0.05) . Before PSM, multivariate Logistic regression analysis showed that elevated serum sodium level〔OR=0.95, 95%CI (0.90, 0.99) 〕 and albumin level [OR=0.95, 95%CI (0.91, 0.99) 〕 were associated with a decreased risk of one-year mortality (P<0.05) , while older age〔OR=1.04, 95%CI (1.02, 1.06) 〕 and hepatic encephalopathy (grade Ⅲ or Ⅳ) 〔OR=3.72, 95%CI (1.21, 11.37) 〕were associated with an increased risk (P<0.05) . After PSM, the one-year mortality was the same in EGVB group (n=145) and control group (n=290) 〔12.4% (18/145) vs 12.4% (36/290) 〕, showing no significant difference (P>0.05) . Moreover, elevated blood urea nitrogen (BUN) 〔OR=1.15, 95%CI (1.02, 1.29) 〕 was an independent risk factor for one-year mortality in EGVB group (P<0.05) , while older age〔OR=1.09, 95%CI (1.04, 1.14) 〕 and elevated neutrophil-to-lymphocyte ratio (NLR) 〔OR=1.09, 95%CI (1.00, 1.18) 〕 acted as independent risk factors for one-year mortality in the control group (P<0.05) .

EGVB had no obvious association with one-year mortality in liver cirrhosis patients. But there were considerable discrepancies in the risk factors affecting one-year mortality between the two groups. Elevated BUN was the independent risk factor for one-year mortality in the EGVB group, while older age and elevated NLR were independent risk factors for one-year mortality in the control group. These results provide a new reference for clinical follow-up and treatment of patients with liver cirrhosis.

Helicobacter pylori (H. pylori) infection induced precancerous lesions of gastric mucosa mostly in adulthood. However, it is debatable whether these pathological changes could also occur in children.

To investigate the relationship between H. pylori infection and precancerous lesions of gastric mucosa in children hospitalized due to upper gastrointestinal symptoms in central plain area of China.

A total of 1 015 children under the age of 18 years old were enrolled. These children attended the People's Hospital of Zhengzhou University for upper gastrointestinal symptoms such as abdominal pain, bloating, nausea, vomiting, hiccups, and acid reflux from August 2018 to July 2021. All children underwent gastroscopy, from which gastric mucosal biopsy tissues were taken for rapid urease test and histopathological examination. The clinical and pathological data of the patients were collected retrospectively. The children were divided into infected and uninfected groups according to H. pylori infection status. The age, sex, endoscopic diagnosis, and H. pylori infection rate were compared between children in infected and uninfected groups. The incidence of precancerous lesions of gastric mucosa, inflammatory activity and the degree of inflammatory cell infiltration were compared between infected and uninfected groups, meanwhile these tests were also compared in children of different age groups.

Among the 1 015 children, 854 (84.14%) were infected with H. pylori and 161 (15.86%) were not infected. H. pylori-infected children were significantly older than those of non-infected subjects (P<0.05). Endoscopy examination revealed that the proportion of chronic superficial gastritis in H. pylori- infected group was significantly higher than that in uninfected group, while nodular gastritis was more common in H. pylori-uninfected patients (P<0.05). Among the enrolled children, 54 were 1-4 years old, 199 were 5-8 years old, 435 were 9-12 years old, and 327 were 13-18 years old. H. pylori infection rate in groups of 5-8, 9-12 and 13-18 year-old children was significantly higher than that in group of 1-4 year-old children; and the infection rate in groups of 9-12 and 13-18 year-old children was also significantly higher than that in group of 5-8 year-old children (P<0.05). Among H. pylori-infected patients, 37 out of 854 children had precancerous lesions of gastric mucosa (with incidence rate of 4.33%), of which 17 patients had atrophy, 11 patients had intestinal metaplasia and 9 patients had dysplasia, and only one of the 161 H. pylori-uninfected patients (0.62%) had atrophic gastritis. The incidence of precancerous lesions of gastric mucosa in H. pylori-infected patients were significantly more than those uninfected patients (χ²=5.178, P=0.023). The level of active inflammation and inflammatory cell infiltration of gastric mucosa in H. pylori-infected children were higher than that in non-infected children (P<0.05). In groups of 5-8, 9-12 and 13-18 year-old children, the prevalence of active inflammation and neutrophil granulocyte infiltration in gastric mucosa were significantly higher than that in uninfected patients (P<0.05). In H. pylori-infected patients, children in groups of 9-12 and 13-18 years old showed more severe lymphocyte infiltration over the uninfected patients (P<0.05) .

In children, gastric mucosal precancerous lesions occur in 4.33% of H. pylori-infected patients in central China, this include atrophic gastritis, intestinal metaplasia and dysplasia; the data revealed an obvious critical issue requiring future investigation and intervention for this group of population.

Inflammatory bowel disease (IBD) is a group of chronic non-specific gastrointestinal inflammatory conditions, whose pathogenic factors and pathogenesis may be related to environmental factors, genetic susceptibility, gut microbiota and immune responses. Ferroptosis is a newly found cell death caused by the accumulation of iron-dependent lipid hydroperoxides, which is tightly regulated by a lipid repair system including glutathione (GSH) and glutathione peroxidase 4 (GPx4). Increasing studies have reported the fundamental features of ferroptosis in the injured gastrointestinal tract in IBD patients, including iron deposition, GSH exhaustion, GPx4 inactivation, and lipid peroxidation. Furthermore, regulating the key ferroptosis-related genes may alter the progression, severity, or even morbidity of IBD. We reviewed the basic mechanism of ferroptosis, and the prospect of ferroptosis pathways as therapeutic targets in IBD. In addition, the initiation of ferroptosis for improving IBD by extrinsic (transporter-dependent) or intrinsic (enzyme-regulated) pathway, may be a new direction for clinical treatment of IBD.

In 2024, the National Comprehensive Cancer Network (NCCN) has updated three editions of the Clinical Practice Guidelines for Gastric Cancer. These updates encompass multiple crucial areas of diagnosis, treatment, and follow-up monitoring for gastric cancer. It elevates the significance of next-generation sequencing in precision therapy for gastric cancer, refines the limitations for Epstein-Barr virus (EBV) testing and first-line immunotherapy in advanced stages. Adjustments have been made to the preoperative medication cycle for neoadjuvant immunotherapy, a new NTRK-targeted therapy drug was added in the second-line therapy, and a more detailed approach to postoperative monitoring and supplementation for nutritional deficiencies has been introduced. Notably, this version marks the first inclusion of endoscopic treatment pathways for early-stage gastric cancer and diagnostic and treatment pathways for single peritoneal metastasis in advanced gastric cancer. Additionally, it provides a comprehensive elaboration on the application principles of several emerging surgical techniques combined with intraperitoneal treatments. The updated content fully embodies the trend towards precision, personalized, and multidisciplinary treatment. This article will focus on the diagnosis, surgical treatment, systemic treatment, follow-up monitoring and other aspects of the guideline, in order to provide guidance and help for clinical practice.

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have proved to have a certain significance in predicting the severity of pancreatitis, however, at present, there are few relevant studies on the diagnostic and predictive value of NLR and PLR for liver injury in biliary acute pancreatitis (BAP) .

To explore the correlation between NLR and PLR in the severity of BAP and the concurrent acute liver injury (ALI) .

A total of 142 patients with BAP admitted to Emergency Department of the Second Affiliated Hospital of Nanchang University from March 2019 to March 2021 were selected and divided into mild (MAP) /moderately (MSAP) group (n=98) and severe (SAP) group (n=44) according to Atlanta classification. According to whether the liver function is damaged or not, they were divided into ALI group (n=92) and non-ALI group (n=50) . The ALI group was further divided into hepatocyte type liver injury subgroup (n=1) , bile duct type liver injury subgroup (n=16) and mixed type liver injury subgroup (n=75) . The general condition and clinical data of patients were collected, and the predictive value of NLR and PLR on the severity of BAP and concurrent ALI was explored by the ROC curve and binary Logistic regression analysis.

The NLR and PLR in MAP/MSAP group were lower than those in SAP group (P<0.05) . The NLR and PLR in ALI group were higher than those in non-ALI group (P<0.05) . There was no significant difference in NLR and PLR between bile duct type liver injury subgroup and mixed type liver injury subgroup (P>0.05) . The area under the ROC curve of NLR, PLR and their joint prediction of SAP was 0.809, 0.667, 0.809, respectively. The area under the ROC curve of NLR, PLR and their joint prediction of ALI in BAP was 0.774, 0.767, 0.806, respectively. The area under the ROC curve of NLR, PLR and their joint prediction of the occurrence of cholangiocytic liver injury in BAP was 0.813, 0.742, 0.861, respectively. The area under ROC curve of NLR, PLR and their joint prediction of mixed liver injury in BAP was 0.763, 0.770 and 0.794 respectively. The results of binary Logistic regression analysis showed that elevated NLR was a risk factor for SAP〔OR=1.184, 95%CI (1.102, 1.271) , P<0.001〕. Elevated NLR and PLR were the risk factors for ALI in BAP〔OR=1.140, 95%CI (1.050, 1.238) , P=0.002; OR=1.007, 95%CI (1.001, 1.013) , P=0.023〕; elevated NLR was a risk factor for bile duct cell liver injury in BAP〔OR=1.184, 95%CI (1.054, 1.331) , P=0.004〕. Elevated NLR and PLR were risk factors for mixed liver injury in BAP〔OR=1.120, 95%CI (1.120, 1.221) , P=0.011; OR=1.007, 95%CI (1.001, 1.013) , P=0.034〕.

Elevated NLR is a risk factor for SAP, elevated NLR and PLR are the risk factors for ALI in BAP. The predictive value of NLR on the severity of BAP and concurrent ALI is better than PLR, and the combined detection effect is better.

Non-alcoholic fatty liver disease (NAFLD) is a common disease of the digestive system. With the improvements of living standards and breakthroughs in viral hepatitis research, NAFLD has replaced viral hepatitis as the most common chronic liver disease. Guidance documents can provide clinical staff with standard and reliable diagnosis and treatment approaches. The screening and development of high-quality guidance documents is of great importance to standardise the clinical practice of NAFLD.

To analyze the methodological quality and reporting quality of guidance documents for NAFLD, summarize and compare the recommendations, so as to provide a reference for the development and report of future guidelines for NAFLD.

PubMed, CNKI, CBM, Wanfang Data Knowledge Service Platform, VIP Database were searched for clinical guidelines and consensuses on NAFLD supplemented by WHO, GIN, NICE, SIGN and Medlive from 2012-01-01 to 2022-01-01. Two researchers in the field of liver disease screened the literature, extracted the data and independently evaluated the methodological quality and reporting quality of the included guideline documents using AGREE Ⅱ and RIGHT, respectively. The recommendations of the higher quality guideline documents were collated and compared by the two researchers.

A total of 19 publications were enrolled, including 12 guidelines and 7 consensuses; 6 in Chinese and 13 in English; 10 of which were developed using an evidence-based approach. The average scores for each domain of AGREE Ⅱ were 42.84% for scope and purpose, 31.43% for participants, 31.25% for rigour, 60.67% for clarity, 32.68% for application and 37.50% for independence. The average scores of RIGHT in each area were 59.65% for basic information, 66.12% for background, 42.11% for evidence, 39.85% for recommendations, 17.11% for review and quality assurance, 18.42% for funding and conflict of interest statement and management, 47.37% for other aspects. The average scores in AGREEⅡ and reporting qualities in RIGHT of evidence-based guidance documents were both higher than non-evidence-based guidance documents. The average scores in AGREEⅡ and reporting qualities in RIGHT of foreign guidance documents were higher than domestic guidance documents. The main recommendations relate to screening and diagnosis, assessment, management (non-pharmacologic and pharmacologic treatment) and surgical treatment.

The methodological quality and reporting quality of the published guidance documents for NAFLD still need to be improved, and there are still gaps between domestic guidance documents and international guidance documents. The development of TCM guidance documents should follow an evidence-based approach. Further reference should be made to international standards such as AGREE Ⅱ and RIGHT in the development and reporting of guidelines. Clinical screening awareness for high-risk population of NAFLD and a comprehensive system for early non-invasive diagnosis and assessment should be established. Multidimensional treatment plans for lifestyle, liver function and metabolic disorders should be provided for patients with NAFLD.

Dyspepsia (namely, the functional dyspepsia) in children, is a common pediatric disease that has a high recurrence rate. Severe dyspepsia will affect the nutritional intake of children, and may further impair their physical development and even mental health.

To systematically review the effectiveness and safety of Changyanning Granules in the treatment of dyspepsia in children.

We searched databases of CNKI, WanFang Data, CQVIP, and SinoMed for randomized controlled trials (RCTs) in Chinese and searched databases of PubMed, The Cochrane Libarary, EMBase, Web of Science for relevant RCTs in English from inception to May 2021. Regarding children with dyspepsia treated by Changyanning Granules or Changyanning Granules in combination with routine western treatment〔Live Combined Bifidobacterium and Lactobacillus Tablets (LCBLT) or Motilium Tablets (MT) 〕 (experimental group) compared with those treated with Xiaoer Xishi Pian (a Chinese patent medicine) or routine western treatment (LCBLT or MT) regardless of dosage, administration route and duration of treatment. We used response rate as the primary outcome indicator, and incidence of adverse reactions and clinical symptoms disappearing time as secondary outcome indicators. We used the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1) and RevMan 5.3 for conducting the meta-analysis.

Six RCTs were included, involving 1 150 cases (575 in the experimental group and 575 in the control group) . Meta-analysis showed that Changyanning Granules were superior to Xiaoer Xishi Pian in terms of overall response rate〔RR=1.57, 95%CI (1.27, 1.94) , P<0.000 1〕 with lower incidence of adverse reactions〔RR=0.18, 95%CI (0.09, 0.37) , P<0.000 01〕. Compared with LCBLT or MT, Changyanning Granules with LCBLT or MT produced higher overall response rate〔RR=1.60, 95%CI (1.13, 2.26) , P=0.008〕, and shortened the clinical symptom disappearing time (P<0.05) , but showed no significant difference in the incidence of adverse reactions (P>0.05) .

For children with dyspepsia, available evidence has demonstrated that using Changyanning Granules alone, or in combination with LCBLT or MT, could improve the overall response rate, shorten the clinical symptoms disappearing time with relatively low incidence of adverse reactions. However, due to low quality of included RCTs, our conclusion needs to be further verified by RCTs meeting the international standards with a large sample size, and rigorous design.

Hypertriglyceridemia has been increasingly valued as a risk factor for acute pancreatitis (AP) . However, the relationship between obesity and AP has not yet been confirmed, whether baseline triglyceride (TG) affects the risk of AP in non-obese people is still inconclusive.

To explore the association between baseline serum triglyceride (TG) and the risk of AP in a nonobese cohort from Kailuan Group.

A prospective cohort study was performed among in-service and retired workers of Kailuan Group (non-obese, without a history of AP, with complete TG information) who first attended the annual health screening for workers of the group as a benefit conducted between 2006 and 2007 or between 2008-2009. The cumulative incidence of AP across serum TG tertile groups: 〔Q1 group (TG≤0.96 mmol/L) , Q2 group (0.96 mmol/L<TG<1.52 mmol/L) , Q3 group (TG≥1.52 mmol/L) 〕was described using Kaplan-Meier curve, and compared by the Log-rank test. The new AP event, death or the end of follow-up (December 31, 2020) was taken as the end point of follow-up. Cox regression model was used to estimate the association of baseline TG levels and new incidence of AP.

The study included a total of 102 358 subjects. Q1, Q2 and Q3 groups had significant differences in sex ratio, average age, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) , and prevalence of smoking, drinking, previous hypertension, previous diabetes, previous cholelithiasis, as well as having at least 9 years of education (P<0.05) . Three hundred and sixteen cases developed AP during an average follow-up of (12.8±2.4) years, with an incidence density of AP of 2.41 per 10 000 person-years. The incidence density was 1.82, 2.22, and 3.17 per 10 000 person-years in Q1, Q2, and Q3 groups, respectively. The cumulative incidence of AP was 2.33%, 2.85% and 4.07%, respectively, in Q1, Q2, and Q3 groups, with statistically differences detected by the log-rank test (χ²=17.27, P<0.001) . By the analysis based on COX regression model 3, the HR of developing AP in Q3 group was 1.66〔95%CI (1.25, 2.19) 〕times higher than in Q1 group after adjusting for sex, age, HDL-C, TC, smoking, drinking, education level, history of hypertension, history of diabetes and history of cholelithiasis, and it was 1.68〔95%CI (1.25, 2.24) 〕times higher than in Q1 group after further excluding the cases suffering from AP within 1 year of follow-up.

A baseline serum TG level of ≥ 1.52 mmol/L may increase the risk of AP in nonobese people.

Diet plays a critical role in the development, progression and prognosis of inflammatory bowel disease (IBD) . Given that specific nutritional guidelines are limited, nutritional management for patients with IBD remains challenging and fraught with uncertainty. Although previous studies have demonstrated that artificial intelligence (AI) shows promising applications in the nutritional management of patients with chronic diseases, research specifically focused on its application in the nutritional management of patients with IBD remains limited.

To conduct a scoping review of studies on AI in nutrition management of patients with IBD.

Following the methodology of scoping reviews, the databases of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, IEEE Xplore, Association for Computing Machinery Digital Library, SinoMed, CNKI, Wanfang Data, and VIP were systematically searched from inception to March 2024 for studies on the application of AI in the nutritional management of patients with IBD. According to the established inclusion and exclusion criteria, two investigators independently screened the literature, and the basic characteristics of the selected studies were extracted.

A total of 15 studies were included. The applications of AI in this field include exploring the relationship between diet and IBD, assisting in nutritional assessment, and aiding nutritional interventions. The majority of utilization AI technologies in the included studies are machine learning, with some also employing additional techniques such as natural language processing and deep neural networks.

AI is beneficial for exploring healthy dietary patterns for patients with IBD and providing personalized nutritional guidance. However, its application in the field of nutritional management in patients with IBD is still in its infancy. Future efforts should focus on strengthening multidisciplinary collaboration, emphasizing the integration of clinical guidelines, and assessing the effectiveness of AI applications in clinical settings to enhance the rigor and accuracy of the results.

The prevalence of metabolic-associated fatty liver disease (MAFLD) has increased rapidly. And there is no conclusion on body fat composition, characteristics of metabolic indicators, and their predictive values for MAFLD in non-obese populations.

To identify the risk factors for MAFLD by comparing body fat composition and key metabolic indicators (blood lipids, blood sugar, uric acid) between obese and non-obese MAFLD patients, and to assess their associations with MAFLD as well as their predictive values for MAFLD in non-obese patients.

Physical examinees with and without liver B-ultrasound-detected fatty liver were recruited from Health Management Center, Nanjing Drum Tower Hospital from January 2018 to January 2019 after excluding those with non-MAFLD, and divided into obese group (including 129 cases with MAFLD, and 129 without fatty liver) and non-obese group (including 129 without fatty liver cases, and 129 with MAFLD) by BMI. The body fat composition and metabolic indices in non-obese MAFLD cases were compared with those of the other three subgroups. The correlation of each index with MAFLD in non-obese cases was analyzed. The independent risk factors of MAFLD in non-obese cases were identified by using Logistic regression. The predictive value of each index for MAFLD in non-obese was assessed using the receiver operating characteristic (ROC) curve.

(1) Comparison of body fat composition and metabolic indicators: compared with non-obese without fatty liver cases, non-obese cases with MAFLD had greater average BMI, body fat (BF), body fat ratio (BFR), visceral fat area (VFA), waist circumference (WC), waist-hip-ratio (WHR), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), alanine transaminase (ALT) and gamma-glutamyl transpeptidase (GGT), and lower high-density lipoprotein cholesterol (HDL-C) (P<0.05). In comparison with obese cases with MAFLD, non-obese cases with MAFLD had lower average BMI, BF, VFA, WC, WHR, fasting plasma glucose (FPG), and glycosylated hemoglobin (HbA_1c) (P<0.05). Non-obese cases with MAFLD had lower average BMI, BF and WC, and higher average TG, UA, ALT and GGT than obese cases without fatty liver (P<0.05). Non-obese female cases with MAFLD had greater average age, BF, BFR and VFA and lower WC, VA, GGT than non-obese male cases with MAFLD (P<0.05). (2) Kendall's rank correlation analysis showed that the risk of MAFLD in non-obese cases increased with the growth of BFR, VFA, WHR, TC, TG, LDL-C, UA, ALT, and GGT (r=0.099, 0.092, 0.136, 0.095, 0.176, 0.092, 0.114, 0.125, 0.142, P<0.05), but decreased with the growth of HDL-C (r=-0.112, P<0.05). (3) Multivariate Logistic regression analysis showed that TG, ALT, UA, BFR and VFA were risk factors of MAFLD in non-obese cases. (4) The results of ROC analysis of the performance of five indicators predicting MAFLD in non-obese cases were as follows: BFR had an AUC of 0.853〔95%CI (0.807, 0.898) 〕, with 0.789 sensitivity, 0.770 specificity when 22.30% was chosen as the optimal cut-off value; VFA had an AUC of 0.938〔95%CI (0.906, 0.970) 〕, with 0.852 sensitivity, 0.904 specificity when 61.45 cm² was chosen as the optimal cut-off value; TG had an AUC of 0.807〔95%CI (0.754, 0.860) 〕, with 0.822 sensitivity, 0.713 specificity when 1.02 mmol/L was chosen as the optimal cut-off value; UA had an AUC of 0.665〔95%CI (0.599, 0.731) 〕, with 0.605 sensitivity, 0.682 specificity when 356.00 μmol/L was chosen as the optimal cut-off value; ALT had an AUC of 0.752〔95%CI (0.692, 0.812) 〕, with 0.814 sensitivity, 0.770 specificity when 18.35 U/L was chosen as the optimal cut-off value.

Compared with non-obese people without fatty liver, non-obese people with MAFLD had increased BF and visceral fat, abnormal lipid metabolism, elevated levels of UA and transaminase. The risk of MAFLD in non-obese people increased with the increase in TG, ALT, UA, BFR and VFA, but decreased with the increase in HDL-C. BFR, VFA, TG, UA and ALT could partially predict and diagnose MAFLD in non-obese people, providing evidence for the delivery of interventions as soon as possible.

The past nearly 20-year period has seen a sudden increase in the use of artificial intelligence (AI) in esophageal cancer research, and an emergence of many systematic reviews and meta-analyses of the research. However, most of the reviews and meta-analyses only address a single aspect in summary, making it difficult for researchers to gain a comprehensive understanding of the latest developments and research hotspots in the field.

To perform a bibliometric analysis of the use of AI in esophageal cancer research, and the development, hotspots and emerging trend in this field.

All literature in English regarding esophageal cancer research using AI included in the Science Citation Index Expanded database of the Web of Science Core Collection was searched from 2000-01-01 to 2022-04-06. Microsoft Excel 2019, CiteSpace (5.8R3-64bit) and VOSviewer (1.6.18) were used to analyze the literature for annual number of publications, country, author, institution, co-citation and keywords.

Nine hundred and eighteen studies were retrieved, with a total of 23 490 times of being cited. The number of studies published between 2000 and 2016 grew slowly (from 6 to 40), but increased rapidly between 2017 and 2022 (from 62 to 216). Sixty countries, 118 institutions and 5 979 authors were involved in the studies. China (306 articles), the United States (238 articles) and the United Kingdom (113 articles) ranked the top three in terms of number of studies published. The top three institutions in terms of intensity of cooperation were University of Amsterdam (TLS=72), Catherine Hospital (TLS=64) and Eindhoven University of Technology (TLS=53). The top three authors in terms of number of publications were Jacques J G H M Bergman from the Netherlands (n=16), Tomohiro Tada from Japan (n=12), and Fons Van Der Sommen from the Netherlands (n=12). There were 39 962 co-cited authors and 42 992 co-cited studies. Thirty-three burst keywords were identified: the major burst keywords were p53 and mutations in 2001-2008 (early stage), and were esophageal cancer classification, new examination techniques (tomography), differentiation, identification and comparison between esophageal cancer and other cancers in 2013-2018 (middle stage), and were deep learning, convolutional neural network, and machine learning in esophageal cancer examination and diagnosis applications in 2019-2022 (late stage). Among which deep learning had the highest burst intensity (burst intensity of 13.89) .

AI application in esophageal cancer research has entered a new phase, moving gradually from genes and mutations toward accurate examination, diagnosis, and treatment. The latest major burst keywords in recent years (2019-2022) are deep learning, convolutional neural network, and machine learning in esophageal cancer examination and diagnosis. The future challenges to the use of AI in esophageal cancer research may include individual data collection, data quality assurance, data processing specifications, AI code reproduction, and reliability assurance of AI-assisted diagnostic decision-making.

Preoperative frailty is a severely unhealthy status that reflects the reduction of overall physiological reserve, which is highly prevalent in elderly patients with gastric cancer. Understanding the perceived influencing factors of preoperative frailty can provide an important basis for developing individualized intervention plans.

To perform a qualitative descriptive study to identity the perceived influencing factors of preoperative frailty among elderly gastric cancer patients using the theory of health ecology.

A qualitative descriptive study was conducted based on health ecology theory. Purposive sampling method was used to select 29 frail elderly patients who would undergo gastric cancer surgery in the First Affiliated Hospital with Nanjing Medical University from February to June 2021 for semi-structured interview. Directed content analysis was used for data analysis.

Five themes and thirteen sub-themes were extracted: physiological traits, including accumulated aging-related losses, obvious gastrointestinal symptoms, and successive attacks of multiple diseases; behavioral characteristics, including lack of exercise behavior and overexertion; interpersonal networks, including insufficient peer social interaction, lack of parent-child interaction, and lack of communication and self-disclosure between couples; living and working conditions, including heavy individual financial burden, heavy unplanned family care tasks, insufficient information resources for health and disease management; macro factors, including limited medical services and medical insurance support.

This study described the effects of different perceived factors on preoperative frailty among elderly gastric cancer patients from the perspective of health ecology. Medical workers should formulate and implement systematic prehabilitation programs based on the above factors to improve the patients' preoperative anti-stress capacity and postoperative outcomes.

China has a large baseline number of patients with hepatitis B virus (HBV) -related chronic liver disease, and it is urgently to contain HBV infection prevalence. To do this, the issue that needs to be addressed quickly is transforming the hospital-based management into community-, hospital-, patient- and society-based management.

To quantify preferences of health management in patients with HBV-related chronic liver disease from Hubei Province, providing a basis for the development of strategies for containing chronic hepatitis disease and for managing such patients.

From July 2018 to July 2019, a discrete choice experiment survey was carried out with a multistage random sample of 180 patients with HBV-related chronic liver disease recruited from three cities (Wuhan, Shiyan, and Xiangyang) of Hubei Province using a questionnaire for collecting their general information, and preferences related to health management (choice sets in the discrete choice experiment consist of place for regular health checkups, average monthly expense for health management of HBV-related chronic liver disease, followed health management, and ways of accessing health management information of HBV-related chronic liver disease with different options) . The mixed Logit model developed in 15.0 was used for data analysis.

The response rate of the survey was 89.4% (161/180) . Patients were more tended to choose a management pattern with lower average monthly expense, a hospital as the place for regular medical examinations, self-management or accessing health management information using offline approaches (P<0.05) . The amount of an additional monthly expense that the patients were willing to pay was 256.75 yuan if the place for regular health checkups was changed to a hospital from a community, 96.87 yuan if the management pattern was changed to self-management from a patient support group-based management, and 52.94 yuan if the approaches for accessing health management information were changed to offline from online. Compared with other choices, the change in the place for regular health checkups from a community to a hospital was the most popular in the patients (willingness increased by 87.29%) .

Patients with HBV-related chronic liver disease preferred to undergo regular health checkups and access health management information in hospitals, but were less likely to contract a family doctor or invest in health. To improve the containment of chronic liver disease, we put forward the following recommendations: strengthening hospitals' capabilities in treating HBV-related chronic liver disease, and their services delivered by a family doctor team, guiding patients to change the idea of "focusing on treatment rather than prevention", and delivering integrated online and offline services.

Inflammatory bowel disease (IBD) is a chronic non-specific intestinal inflammatory disease featured by repetitive episodes of gastrointestinal inflammation, including ulcerative colitis and Crohn's disease. The etiology and pathogenesis of IBD have not been fully identified, and there is still no cure currently. Nevertheless, new treatments have been developed recently, such as biological agents and small-molecule drugs, stem cell transplantation, fecal bacteria transplantation, and monocyte adsorption apheresis, along with the roles of TNF-α, interleukin, integrin receptors, JAK/STAT pathway and intestinal flora in the pathophysiology of IBD gradually revealed by increasingly deepening research on IBD. Although many new treatments are still being researched, they have been proven effective and safe, which might make up for the shortcomings of previous therapies, and may be alternative choices for individualized treatment of IBD in the future. This article reviews the recent developments in novel treatments for IBD.

Scale assessment for irritable bowel syndrome (IBS) has been widely implemented in clinical practice, how to choose an appropriate assessment tool is very important. In view of this, we used literature research methodology to search patient-reported outcomes and disease-specific health-related quality of life instruments for IBS, summarized their main contents and psychometric properties, then put forward recommendations on the selection of the instruments. A total of 37 commonly used instruments for IBS were retrieved, which have proven to have good reliability, validity and responsiveness, and can be better applied in clinical practice. We suggest medical professionals and researchers choose an assessment instrument for IBS according to the purpose and content of their research.

As intestinal infectious diseases are one major public health issue in China, there remains an urgent need to dynamically track the incidence trend and epidemiological characteristics of these diseases on the whole or by category.

To analyze the epidemiological characteristics, spatial distribution and clustering features of types A and B intestinal infectious diseases in China from 2008 to 2018, providing a theoretical basis for optimizing the prevention and control strategies of these two types of diseases.

Data on the incidence of types A and B intestinal infectious diseases〔including typhoid and paratyphoid, viral hepatitis (hepatitis A, hepatitis E and undifferentiated type of hepatitis) and dysentery〕in all regions of China (n=31, except for Hong Kong, Macao and Taiwan) from January 2008 to December 2018 were extracted in March 2022, using the Data-center China Public Health Science as the data source. The chi-square test for trend was used to examine the temporal trend of incidence of these two types of diseases. Descriptive epidemiology, spatial autocorrelation, and spatial and temporal clustering analysis were used to analyze the spatio-temporal epidemiological characteristics of the diseases, and to determine the key seasons and regions for epidemic prevention and control.

A cumulative total of 3 220 480 cases of types A and B intestinal infectious diseases were reported in China from 2008 to 2018, with an average annual incidence rate of 7.25/100 000, showing a decline in overall incidence rate (P<0.05) . The incidence rate of typhoid and paratyphoid, viral hepatitis and dysentery demonstrated a downward trend during the period (P<0.05) . The incidence rate of typhoid and paratyphoid decreased from 1.18 per 100 000 population in 2008 to 0.78 per 100 000 population in 2018. The incidence rate of viral hepatitis decreased from 9.81 per 100 000 population in 2008 to 4.34 per 100 000 population in 2018. The incidence rate of dysentery decreased from 23.65 per 100 000 population in 2008 to 6.56 per 100 000 population in 2018. Typhoid, paratyphoid and dysentery occurred more frequently in summer and autumn (from May to October) , while the incidence of viral hepatitis had no obvious changes across seasons. The spatial distribution map of types A and B intestinal infectious diseases in China indicated that, typhoid and paratyphoid had a high incidence rate in Yunnan, Guizhou and Guangxi in western China, viral hepatitis showed a high incidence rate in western China, and dysentery had a high incidence rate in Beijing and Tianjin. The spatial autocorrelation analysis showed that the incidence rate of typhoid and paratyphoid (except that in 2014) , viral hepatitis (except that in 2016) and dysentery in China over the years from 2008 to 2018 was spatially clustered (global Moran's I ranged from 0.09 to 0.24, P<0.05) . The spatial clustering of typhoid and paratyphoid and viral hepatitis was decreased first and then increased, and that of viral hepatitis declined first and then rose, but was weakened in general. The spatial clustering of dysentery was strong. The spatio-temporal scan statistics detected that Yunnan was the region with the highest incidence rate (the primary geographic cluster) of typhoid and paratyphoid during 2009 to 2013, nine regions with Tibet as the center had the highest incidence rate of viral hepatitis from 2008 to 2011, and Beijing and Tianjin were the regions with the highest incidence rate of dysentery from 2008 to 2012.

Having obvious spatial and temporal clustering characteristics, the incidence of types A and B intestinal infectious diseases in China decreased significantly during the period due to effective prevention and control. Our study may be used as a guide to identify key prevention and control areas and to develop prevention and control strategies according to the spatial clustering patterns of different intestinal infectious diseases.

As the most common chronic liver disease, nonalcoholic fatty liver disease (NAFLD) has been reported to be associated with significant changes in myocardial structure and function, but it is still a controversial issue whether it is an independent risk factor for abnormalities in cardiac structure and function.

To assess the correlation of NAFLD with early left ventricular diastolic dysfunction by comparing left ventricular structure and functional indices between NAFLD and non-NAFLD patients.

A total of 519 inpatients from Geriatric Medicine Unit, Peking University People's Hospital were enrolled during 2018 to 2020, and divided into NAFLD group and non-NAFLD group according to the results of abdominal ultrasound or CT examination. Left ventricular structural and functional indices of two groups were comparatively analyzed. Early left ventricular diastolic dysfunction was defined as the ratio of the peak velocity of the early filling (E) wave to the atrial contraction (A) wave <1. Multivariate Logistic regression was used to assess the correlation between NAFLD and early left ventricular diastolic dysfunction. FIB-4 index was used to assess the risk of liver fibrosis in NAFLD patient〔low risk (<1.30) , medium risk (1.30-3.25) , and high risk (>3.25) 〕. NAFLD patients were divided into low-risk subgroup (n=81) and medium-high risk subgroup (n=100) according to whether FIB-4 index <1.30.

Compared with the non-NAFLD patients (n=338) , NAFLD patients had lower E/A ratio〔 (0.79±0.25) vs (0.87±0.34) , t=2.607, P=0.009) 〕 and greater end-diastolic interventricular septal thickness〔 (0.92±0.13) cm vs (0.89±0.13) cm, t=-2.525, P=0.012〕. Multivariate Logistic regression analysis showed that NAFLD was independently associated with the risk of early left ventricular diastolic dysfunction〔OR=2.941, 95%CI (1.736, 4.981) , P<0.001〕. NAFLD patients with medium-high risk subgroup had lower E/A ratio〔 (0.75±0.21) vs (0.84±0.28) , t=2.275, P=0.024〕 and higher left ventricular mass index than did those with low-risk subgroup〔 (80.22±14.92) g/m² vs (74.72±16.83) g/m², t=-2.327, P=0.021〕.

NAFLD may be an independent risk factor for early left ventricular diastolic dysfunction. The higher risk of advanced fibrosis in NAFLD patients, the worse was the left ventricular diastolic function.

Functional dyspepsia (FD) after ischemic stroke belongs to the category of post-stroke gastrointestinal dysfunction, which is prevalent in middle-aged and elderly patients. Stroke patients may differ from the general population in the influencing factors of FD due to their own somatic and psychological changes.

To investigate the associated factors of the severity of functional dyspepsia after ischemic stroke.

A total of 180 middle and old aged patients with functional dyspepsia after ischemic stroke were selected from March 2017 to July 2018 in the Department of Acupuncture of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine. A self-designed dyspepsia symptom score scale was used to evaluate the severity of FD during hospitalization. The patients were divided into mild FD group (score≤7, n=115) and moderate-severe FD group (score>7, n=65) according to the dyspepsia symptom score. Patient data were collected through the medical record system, and multivariate Logistic regression were used to explore the influencing factors of functional dyspepsia severity after ischemic stroke.

The FD symptom scores of 180 patients was in the range of 3-12 points, with an average of (7.2±1.7) points. Among them, 115 patients (63.9%) had symptom score≤7 points, and 65 patients (36.1%) had symptom score>7 points. The severity of functional dyspepsia patients with different ages and stroke duration (acute, convalescent, sequelae) was statistically different (P<0.05) . Multivariate Logistic regression analysis showed middle age (43-55 years) 〔OR=3.367, 95% CI (1.399, 8.104) , P=0.007〕and thalamus infarction〔OR=2.111, 95%CI (1.038, 4.290) , P=0.039〕 were the influencing factors of the severity of functional dyspepsia after ischemic stroke.

Age 43 to 55 years and thalamic infarction are risk factors for FD severity in patients with ischemic cerebral infarction, which may be used as a basis to evaluate the development of FD and provide a reference for clinicians for early intervention of FD in patients with ischemic stroke.

Cirrhosis is a chronic consumption disease, whose impact on patients' physical function and nutritional status has been increasingly valued by the academic community. It is helpful to promote the innovation and development in nutrition for cirrhosis in China by reviewing the hotspots in global research on nutrition for cirrhosis periodically.

To perform a bibliometric and visualized review of the development, hotspots, and trends of studies on nutrition for cirrhosis published from 1991 to 2021, providing a reference for future studies related to nutrition in cirrhosis.

The studies about nutrition in cirrhosis published during 1991-2021 were searched from the database of Web of Science. Collaboration and co-occurrence network analyses supported by CiteSpace were used for data mining and visualization analysis of countries, institutions, authors, keywords, and burst keywords relevant to studies of nutrition in cirrhosis .

A total of 1 520 studies were finally included, the yearly number of these studies demonstrated a wave-like growth during the period of 1991-2021, in particular, it exceeded 100 in 2020 and 2021. The U.S. ranked first in terms of the number of published studies (424) and intermediary centrality value (0.32). As for institutions, Mayo Clinic (the U.S.) ranked first in terms of the number of published studies (25) and intermediary centrality value (0.08), followed by Gifu University (Japan), Cleveland Clinic (the U.S.), and Aarhus University Hospital (Denmark). Inter-institutional collaborative networks were formed in the U.S., with Mayo Clinic and Cleveland Clinic, as the core, and in Europe, with Charite (Germany) and Karolinska Institute (Sweden) as the core. A total of 891 authors were included in the collaborative network, represented by TANDON P and KAWAGUCHI T. High-frequency keywords included nutritional status, liver transplantation, and body composition. Sarcopenia was the keyword with the strongest citation bursts (strength 26.170 9) .

Nutritional assessment, liver transplantation and body composition may be hot topics in research on nutrition in cirrhosis. And the pathophysiological mechanisms of malnutrition and nutritional management in patients with cirrhosis and sarcopenia may be foci of future research.

Hepatokines are a variety of proteins secreted by the liver, a key organ involved in systemic metabolism and endocrine, directly affect the liver glycolipid metabolism, and play an important role in the development of nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM). Ectodysplasin A (EDA) is a newly discovered hepatokine, which is considered to be strongly related to diabetes, obesity and insulin resistance.

To assess the relationship between serum EDA level and the risk of NAFLD in patients with T2DM.

One hundred and thirty T2DM patients, including 74 males (56.92%) and 56 females (43.08%), with a mean age of (55.6±12.4) years, were recruited from Department of Endocrinology, Affiliated Hospital of Jiangsu University between November 2017 and November 2020. Baseline data, results of glucose tolerance test, insulin response test, C-peptide response to glucagon test, and color Doppler ultrasound of the abdomen were collected. Baseline data were compared between patients with ultrasound-detected NAFLD (n=80) and those without (n=50). Pearson correlation analysis was used to evaluate the correlation between serum EDA and the other clinical and biochemical indices. Multiple linear regression analysis was used to explore the influencing factors of EDA level. Multivariate Logistic regression analysis was used to explore the effect of EDA level on the risk of NAFLD.

Compared with non-NAFLD group, NAFLD group had much younger mean age, shorter mean duration of T2DM, but significantly higher mean levels of BMI, fasting insulin (FIns), 2-hour postprandial insulin responses (2 hIns), fasting C-peptide (FCP), 2-hour postprandial C-peptide (2 hCP), homeostasis model assessment of insulin resistance (HOMA-IR), triacylglycerol (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood uric acid (SUA), urea nitrogen (BUN), and EDA level (P<0.05). Pearson correlation analysis showed that the serum EDA level was positively correlated with age, FIns, 2 hIns, HOMA-IR, and AST (r=0.222, 0.186, 0.233, 0.204, 0.189, P<0.05). Multiple linear regression analysis showed that age〔β=1.957, 95%CI (0.412, 3.502), P=0.013〕, WHR〔β=-328.845, 95%CI (-638.903, -18.788), P=0.038〕, 2 hIns〔β=0.523, 95%CI (0.036, 1.011), P=0.036〕 and AST〔β=2.148, 95%CI (0.520, 3.776), P=0.010〕were independently associated with EDA (P<0.05). Multivariate Logistic regression analysis demonstrated that EDA was still associated with NAFLD after adjusting for multiple confounding factors〔OR=1.006, 95%CI (1.002, 1.010), P=0.007〕.

In T2DM patients with NAFLD, the level of serum EDA was significantly increased, and potentially associated with elevated risk of NAFLD, which suggests that serum EDA level may play a role in the development of NAFLD in T2DM. Our study may provide a theoretical basis for early screening or treatment of NAFLD.

Targeted therapies and immunotherapies, represented by programmed cell death protein 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) inhibitors, have demonstrated high efficacies in multiple cancers. China-produced PD-1/PD-L1 inhibitors have been approved for use recently.

To investigate the efficacy and safety of China-produced camrelizumab, a PD-1 inhibitor, in combination with apatinib in the first-line treatment of middle and advanced stages of primary liver cancer.

Eighty-six patients with middle and advanced stages of primary liver cancer were selected from the oncology department of four hospitals in Chizhou (the People's Hospital of Chizhou, Chizhou Second People's Hospital, Dongzhi County People's Hospital, Shitai County People's Hospital) from June 2018 to January 2021. All patients were initially treated with apatinib mesylate tablets and intravenous infusion of China-produced camrelizumab, and followed up till August 31, 2021 with disease progression or all-cause death as the endpoint. Clinical efficacies were assessed at the end of the first and third months of treatment. The treatment-emergent adverse events were counted.

There were no dropouts due to serious treatment-emergent adverse events. The overall response rate (ORR) and disease control rate (DCR) in the patients were 58.14% (50/86) and 65.12% (56/86) , respectively, at the end of the first month of treatment, and were 76.74% (66/86) and 82.56% (68/86) , respectively, at the end of the third month of treatment. The follow-up period for them ranged from four to 26 months, with a mean value follow-up time of (12±6) months. A total of 35 patients died during the follow-up. The median progression-free survival was 8〔95%CI (5.18, 11.89) 〕 months, and the median overall survival was 12〔95%CI (8.97, 15.97) 〕 months in all patients. The major treatment-emergent adverse events included gastrointestinal reactions〔52 (60.47%) 〕, secondary hypertension〔31 (36.05%) 〕, hand-foot syndrome〔18 (20.93%) 〕 and proteinuria〔12 (13.95%) 〕, among which gastrointestinal reactions (6.98%) in six cases, secondary hypertension (2.33%) in two cases and hand-foot syndrome (1.16%) in one case were grade 3-5 adverse events.

For middle and advanced stages of primary liver cancer, China-produced camrelizumab with apatinib as the first-line treatment has good effect with controllable adverse events.

The number of researches on the application of artificial intelligence (AI) to diagnosis and treatment of gastric cancer has been increasing in recent years, but no researcher has systematically analyzed it using bibliometric analysis.

To analyze the researches on the application of AI to diagnosis and treatment of gastric cancer, explore the research hotspots and development trends from 2003 to 2022. Methods On November 06, 2022, Web of Science (WOS) core collection database was searched by computer to obtain studies on the application of AI to gastric cancer diagnosis and treatment, and VOSviewer 1.6.18 software was used to visualize and analyze inter-country (region), inter-institution, and inter-author collaborations, co-cited authors, keyword co-occurrences and overlays through bibliometric analysis. CiteSpace 5.7.R5 software was used to perform institutional betweenness centrality analysis, journal biplot overlay, cluster analysis of co-cited literature for the last 6 years, co-cited literature clustering timeline graph analysis and reference bursting analysis. Excel 2019 software was used to plot bar graphs of the volume of publications and descriptive analysis tables of countries (regions), institutions, journals, authors, cited references and keywords.

A total of 703 papers were included, and the annual publication volume of the application of AI to gastric cancer diagnosis and treatment showed an overall increasing trend from 2003-2022, with a rapid increase after 2017 and the most rapid growth from 2019-2021. The top publishing country, institution and author was China, Chinese Academy of Sciences and TADA TOMOHIRO, respectively. The top three co-cited authors of BRAY FREDDIE, HIRASAWA TOSHIAKI and JIANG YUMING had made significant contributions to the field. Frontiers in Oncology was the journal with the highest publication volume, and Gastrointestinal Endoscopy was the most influential journal among the top ten journals for researches related to the application of AI to the diagnosis and treatment of gastric cancer. The citing journals mainly focused on the two fields of "Medicine, Medical, Clinical" and "Molecular, Biology, Immunology". And the cited journals mainly focused on the two fields of "Molecular, Biology, Genetics" and "Health, Nursing, Medicine". The top-ranked literature in terms of total citations titled Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. All keywords were classified into 4 categories based on keyword clustering results, including AI-assisted biological research of gastric cancer, AI-assisted endoscopic diagnosis of gastric cancer, AI-assisted pathological diagnosis of gastric cancer, and AI-assisted non-endoscopic treatment and prognosis prediction of gastric cancer. Deep learning, convolutional neural network, imaging histology, gastrointestinal endoscopy, pathology and immunotherapy were the current research hotspots.

AI has a broad application prospect in gastric cancer diagnosis and treatment, and more and more scholars are devoted to AI in gastric cancer diagnosis and treatment. Currently, AI has been widely studied in the biology, diagnosis, staging, efficacy assessment and prognosis prediction of gastric cancer. The results of this study can provide a reference for scholars engaged in research work related to AI and gastric cancer.

Visceral hypersensitivity is one major pathophysiological characteristic of irritable bowel syndrome (IBS) , a common functional bowel disorder. The detection and evaluation of visceral hypersensitivity are of practical significance for the guidance of clinical diagnosis and treatment of IBS. We reviewed the latest studies on the detection and evaluation methods of visceral hypersensitivity mediated by both peripheral and central factors in IBS patients and animal models, and found some limitations in these studies such as monotonous evaluation methods, and limited applications of the methods. The possible applications of these methods in both animal experiments and clinical trials can be explored in future researches.

Dietary components can produce a variety of bioactive substances that maintain a low inflammatory state in the body and participate in the formation of the tumor microenvironment. The dietary inflammatory index (DII) is a new indicator to quantify the inflammatory potential of diet. High DII score is closely associated with the risk of colorectal cancer, but its relationship with upper gastrointestinal cancer (UGIC) is unclear.

This study was conducted to assess the relationship between DII and the risk of UGIC, providing a scientific basis for dietary guidance.

We did a systematic search of PubMed, Web of Science, Embase and the Cochrane Library for studies on the association of DII score and UGIC published in English, and Wanfang Data, CNKI and VIP for those published in Chinese, from inception to October 10, 2022. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.4.1 was used for meta-analysis and subgroup analysis.

A total of 11 case-control studies including 9 051 participants were included in this study. Meta-analysis showed that high DII score were associated with an increase in the risk of UGIC〔OR=1.81, 95%CI (1.65, 1.97), P<0.05〕. High DII score also significantly increased the risk of esophageal and gastric cancers〔OR=2.20, 95%CI (1.69, 2.86) ; OR=1.79, 95%CI (1.44, 2.24), P<0.05〕. Subgroup analysis showed that high DII score increased the risk of UGIC by 131% in the European population〔OR=2.31, 95%CI (1.78, 3.00), P<0.05〕, and 98% in the Asian population〔OR=1.98, 95%CI (1.55, 2.53), P<0.05〕. High DII score increased the risk of UGIC by 161% in women〔OR=2.61, 95%CI (1.79, 3.79), P<0.05〕. Moreover, high DII score increased the risk of UGIC by 47% in H. pylori-negative populations〔OR=1.47, 95%CI (1.08, 1.99), P<0.05〕, and 90% in H. pylori-positive populations〔OR=1.90, 95%CI (1.33, 2.71), P<0.05〕. High DII score was associated with a 195% increased risk of UGIC in the population with interviewer-administered Food Frequency Questionnaire (FFQ) 〔OR=2.95, 95%CI (1.96, 4.43), P<0.05〕, and a 68% increased risk of UGIC in the population with self-administered FFQ〔OR=1.68, 95%CI (1.53, 1.85), P<0.05〕. High DII score was associated with a 101% increased risk of UGIC in the population with a higher number of DII components (>30) 〔OR=2.01, 95%CI (1.57, 2.57), P<0.05〕, and a 125% increased risk of UGIC in the population with a lower number of DII components (<30) 〔OR=2.25, 95%CI (1.58, 3.22), P<0.05〕. In addition, high DII score increased the risk of UGIC by 123% in the population with energy-adjusted diet〔OR=2.23, 95%CI (1.85, 2.68), P<0.05〕, and 70% in the population without energy-adjusted diet〔OR=1.70, 95%CI (1.53, 1.88), P<0.05〕. The funnel plot of the literature was asymmetric, showing that there was a certain publication bias.

A pro-inflammatory diet with higher DII score may exacerbate the risk of UGIC, especially in esophageal cancer patients and in the female population.

Due to great differences in physiological reserve, psychological status and social functioning, frailty in elderly patients with gastric cancer may present various subtypes. The relationship between preoperative frailty and postoperative adverse outcomes in them still remains to be further explored.

To explore the relationship between preoperative frailty subtypes and postoperative adverse outcomes〔total complications, prolonged length of stay (PLOS), low quality of life (QOL), and disability〕among elderly patients with gastric cancer.

From March to October 2021, 404 elderly gastric cancer patients were selected from Department of Gastric Surgery, the First Affiliated Hospital with Nanjing Medical University by convenience sampling. The General Demographic Data Questionnaire and Tilburg Frailty Indicator were used to collect demographics and frailty status before surgery. Total complications and PLOS were collected from the electronic medical records, and the status of disability and QOL were obtained using a telephone follow-up at one month after discharge. Univariate Logistic regression was performed to explore the influencing factors of postoperative adverse outcomes. Multivariate Logistic regression analysis was performed to analyze the association of preoperative frailty subtypes with postoperative adverse outcomes, with potential confounders adjusted.

Two hundred and eighty-five cases were found with preoperative frailty, and the frailty subtypes in them were classified into eight classes: exclusive physical frailty〔77 (19.1%) 〕, exclusive psychological frailty〔78 (19.3%) 〕, exclusive social frailty〔23 (5.7%) 〕, physical and psychological frailty〔63 (15.6%) 〕, physical and social frailty〔13 (3.2%) 〕, psychological and social frailty〔16 (4.0%) 〕, multidimensional frailty (physical, psychological, and social frailty) 〔15 (3.7%) 〕. The other 119 (29.5%) cases had no preoperative frailty. In the univariate Logistic regression, age was the factor influencing total complications〔OR=1.063, 95%CI (1.021, 1.106), P=0.003〕. History of pharmacological treatment〔OR=1.549, 95%CI (1.016, 2.362), P=0.042〕and surgical approach〔OR=2.103, 95%CI (1.191, 3.712), P=0.010〕were the factors influencing PLOS. Marital status〔OR=4.611, 95%CI (1.079, 19.706), P=0.039〕, living in an urban area〔OR=1.614, 95%CI (1.009, 2.582), P=0.046〕, having at least two comorbidities〔OR=1.694, 95%CI (1.038, 2.766), P=0.035〕were the factors influencing postoperative low QOL. Living in an urban area〔OR=0.601, 95%CI (0.390, 0.926), P=0.021〕, history of pharmacological treatment〔OR=1.663, 95%CI (1.082, 2.558), P=0.020〕, and advanced TNM stages〔OR=1.659, 95%CI (1.017, 2.706), P=0.043〕were the factors influencing postoperative disability. In the multivariate Logistic regression, the preoperative multidimensional frailty was independently associated with total complications, with age adjusted〔OR=5.344, 95%CI (1.715, 16.656), P=0.004〕. The preoperative physical frailty〔OR=2.048, 95%CI (1.078, 3.891), P=0.029〕, preoperative psychological frailty〔OR=2.077, 95%CI (1.103, 3.913), P=0.024〕and preoperative multidimensional frailty〔OR=8.321, 95%CI (2.400, 28.848), P<0.001〕were independently associated with PLOS, with history of pharmacological treatment and surgical approach adjusted. Preoperative psychological frailty〔OR=2.620, 95%CI (1.267, 5.418), P=0.009〕, preoperative psychological and social frailty〔OR=11.122, 95%CI (3.253, 38.028), P<0.001〕and preoperative multidimensional frailty〔OR=11.579, 95%CI (2.835, 47.302), P<0.001〕were independently associated with postoperative low QOL, with marital status, living in an urban area, and having at least two comorbidities adjusted.

Medical professionals should pay attention to preoperative frailty prevalence in elderly gastric cancer patients, and assess preoperative frailty in these patients using tools with the multidimensional frailty scale included, and attach great importance to those with exclusive physical frailty, exclusive psychological frailty, psychological and social frailty, and multidimensional frailty before surgery. A targeted prerehabilitation intervention program can be delivered to those with preoperative frailty according to their subtypes of frailty to improve postoperative adverse outcomes and QOL.