Publications by authors named "Yin Zhu"

244 Publications

Pancreatic necrosis volume for predicting readmission and reintervention in acute necrotizing pancreatitis.

Eur J Radiol 2022 Jun 22;154:110419. Epub 2022 Jun 22.

Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China. Electronic address:

Purpose: To determine the correlation between the pancreatic necrosis volume (PNV) and readmission as well as reintervention.

Method: This was a retrospective cohort study that included necrotizing pancreatitis (NP) patients who were examined with contrast-enhanced computed tomography (CT) one week before discharge. The PNV was calculated manually based on the postprocessing workstation software. Multivariate logistic regression analysis was employed to determine the independent risk factors for readmission and reintervention.

Results: A total of 167 NP patients were included. Among them, 94 (56.3%) patients were readmitted after discharge, and 55 (32.9%) patients needed further invasive intervention. The median PNV of all patients was 376.6 (interquartile range (IQR), 129.3-820.5) cm, and the PNV was significantly higher in patients needing readmission or reintervention. Multivariate analysis showed that PNV ≥ 620 cm (adjusted odds ratio (adjOR), 3.08; 95% confidence interval (CI), 1.47-6.43; P = 0.003) and modified computed tomography severity index (CTSI) score ≥ 7 points (adjOR, 6.36; 95% CI, 2.05-10.70; P = 0.001) were independently associated with readmission. Stent or drainage tube placement at discharge (adjOR, 2.94; 95% CI, 1.27-6.77; P = 0.011), PNV ≥ 620 cm (adjOR, 5.11; 95% CI, 2.19-11.95; P < 0.001), pancreatic parenchymal necrosis (adjOR, 3.37; 95% CI, 1.42-7.96; P = 0.006), and modified CTSI score ≥ 7 points (adjOR, 4.23; 95% CI, 1.46-12.27; P = 0.008) were independent risk factors for reintervention.

Conclusions: The PNV is a useful tool for quantifying pancreatic necrosis and is strongly associated with readmission and reintervention. Additional prospective studies with larger sample sizes are needed to confirm these findings.
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http://dx.doi.org/10.1016/j.ejrad.2022.110419DOI Listing
June 2022

Characterisation of the volatile compounds profile of Chinese pan-fried green tea in comparison with baked green tea, steamed green tea, and sun-dried green tea using approaches of molecular sensory science.

Curr Res Food Sci 2022 8;5:1098-1107. Epub 2022 Jul 8.

Key Laboratory of Tea Biology and Resource Utilization of Ministry of Agriculture, Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou, 310008, China.

Pan-fried green tea (PGT) is an easily acceptable tea drink for general consumers. In this study, volatile profiles and characteristic aroma of 22 representative Chinese PGT samples were extracted using stir bar sorptive extraction (SBSE) and analysed by gas chromatography-mass spectrometry (GC-MS), gas chromatography-olfactometry (GC-O) analysis, and odour activity value (OAV) calculations. In total, 88 volatile compounds were identified. Alcohols (45%), esters (19%), and ketones (16%) were the dominant volatiles, and geraniol (484.8 μg/kg) was the most abundant volatile component in PGT, followed by trans-β-ionone and linalool. In addition, the differences of aroma characteristics among PGT and other three types of green tea, namely baked green tea, steamed green tea, and sun-dried green tea, were also observed using partial least squares discriminant analysis (PLS-DA) and heatmap analysis, and it was found that β-myrcene, methyl salicylate, ()-nerolidol, geraniol, methyl jasmonate were generally present at higher content in PGT. This is the first comprehensive report describing the volatile profiles of Chinese PGT, and the findings from this study can advance our understanding of PGT aroma quality, and provide important theoretical basis for processing and quality control of green tea products.
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http://dx.doi.org/10.1016/j.crfs.2022.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287605PMC
July 2022

Integrated analysis of colorectal cancer reveals cross-cohort gut microbial signatures and associated serum metabolites.

Gastroenterology 2022 Jul 1. Epub 2022 Jul 1.

Diagnostic and treatment center for refractory diseases of abdomen surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China; Institute for Intestinal Diseases, Tongji University School of Medicine, Shanghai 200072, China; Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China. Electronic address:

Background & Aims: Studies have reported abnormal gut microbiota or circulating metabolome associated with colorectal cancer (CRC), but it remains a challenge to capture the CRC-relevant features consistent across geographic regions. This is particularly the problem for metabolic traits of CRC, because the analyses generally use different platforms and laboratory methods, which poses a barrier to cross-dataset examination. In light of this, we wish to elucidate the microbial and metabolic signatures of CRC with broad population relevance.

Methods: In this integrated metagenomic (healthy controls (HC) = 91, colorectal adenoma (CRA) = 63, CRC = 71) and metabolomic (HC = 34 , CRA = 31, CRC = 35) analysis, CRC-associated features and microbe-metabolite correlations were first identified from a Shanghai cohort. A gut microbial panel was trained in the in-house cohort and cross-validated in 7 published metagenomic datasets of CRC. The in-house metabolic connections to the cross-cohort microbial signatures were used as evidence to infer serum metabolites with potentially external relevance. In addition, a combined microbe-metabolite panel was produced for diagnosing CRC or adenoma.

Results: CRC-associated alterations were identified in the gut microbiome and serum metabolome. A composite microbe-metabolite diagnostic panel was developed and yielded an area under the curve of 0.912 for adenoma and 0.994 for CRC. We showed that many CRC-associated metabolites were linked to cross-cohort gut microbiome signatures of the disease, including CRC-enriched leucylalanine, serotonin, and imidazole propionate and CRC-depleted perfluorooctane sulfonate, 2-linoleoylglycerol (18:2) and sphingadienine.

Conclusions: We generated cross-cohort metagenomic signatures of CRC, some of which linked to in-house CRC-associated serum metabolites. The microbial and metabolic shifts may have wide population relevance.
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http://dx.doi.org/10.1053/j.gastro.2022.06.069DOI Listing
July 2022

Predicting persistent organ failure on admission in patients with acute pancreatitis: development and validation of a mobile nomogram.

HPB (Oxford) 2022 Jun 6. Epub 2022 Jun 6.

Department of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China. Electronic address:

Background: Early prediction of persistent organ failure (POF) is important for triage and timely treatment of patients with acute pancreatitis (AP).

Methods: All AP patients were consecutively admitted within 48 h of symptom onset. A nomogram was developed to predict POF on admission using data from a retrospective training cohort, validated by two prospective cohorts. The clinical utility of the nomogram was defined by concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC), while the performance by post-test probability.

Results: There were 816, 398, and 880 patients in the training, internal and external validation cohorts, respectively. Six independent predictors determined by logistic regression analysis were age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion and were included in the nomogram (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This nomogram had reasonable predictive ability (C-indexes 0.88/0.91/0.81 for each cohort) and promising clinical utility (DCA and CIC). The nomogram had a positive likelihood ratio and post-test probability of developing POF in the training, internal and external validation cohorts of 4.26/31.7%, 7.89/39.1%, and 2.75/41%, respectively, superior or equal to other prognostic scores.

Conclusions: This nomogram can predict POF of AP patients and should be considered for clinical practice and trial allocation.
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http://dx.doi.org/10.1016/j.hpb.2022.05.1347DOI Listing
June 2022

Comprehensive investigation on non-volatile and volatile metabolites in four types of green teas obtained from the same tea cultivar of Longjing 43 (Camellia sinensis var. sinensis) using the widely targeted metabolomics.

Food Chem 2022 Nov 17;394:133501. Epub 2022 Jun 17.

Key Laboratory of Tea Biology and Resource Utilization of Ministry of Agriculture, Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou 310008, China. Electronic address:

In this study, we produced roasted, baked, steamed, and sun-dried green tea products using the same batch of fresh tea leaves (FTL) of Longjing 43 (Camellia sinensis var. sinensis), and explored processing effects on the metabolic profiles of four types of green teas (FGTs) using the widely targeted metabolomics. Results showed that 146 differential metabolites including flavonoids, amino acids, lipids, and phenolic acids were screened among 1034 non-volatiles. In addition, nineteen differential metabolites were screened among 79 volatiles. Most of non-volatiles and volatiles metabolites changed notably in different manufacturing processes, whereas there were no significant differences (p>0.05) in the levels of total catechins between FGTs and FTL. The transformation of metabolites was the dominant trend during green tea processing. The results contribute to a better understanding of how the manufacturing process influences green tea quality, and provide useful information for the enrichment of tea biochemistry theory.
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http://dx.doi.org/10.1016/j.foodchem.2022.133501DOI Listing
November 2022

Dynamic Changes and Nomogram Prediction for Sinistral Portal Hypertension in Moderate and Severe Acute Pancreatitis.

Front Med (Lausanne) 2022 26;9:875263. Epub 2022 May 26.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Objectives: To investigate the dynamic changes in gastric varices in patients with acute pancreatitis (AP) and to develop a novel nomogram for the early prediction of sinistral portal hypertension (SPH).

Methods: This was a retrospective, case-control study with an analysis of the quantitative, dynamic computed tomography imaging results of SPH in patients with moderate and severe AP with a long-term follow-up. Multivariate logistic regression analysis and nomogram were employed.

Results: The SPH group ( = 94) and non-SPH group ( = 94) were matched. The dynamic changes showed an increasing trend in the diameter of gastric fundus, short gastric, gastric coronary, and gastroepiploic veins, which did not recover during the one-year follow-up. Multivariate analysis showed that male (adjusted odds ratio (adjOR), 8.71; 95% confidence interval (CI), 2.86-26.53; < 0.001), body mass index ≥27.5 kg/m (adjOR, 5.49; 95% CI, 1.85-16.29; = 0.002), prothrombin time ≥12.6 s (adjOR, 2.82; 95% CI, 1.11-7.17; = 0.03), and the patency of splenic vein [stenosis (adjOR, 8.48; 95% CI, 2.13-33.71; = 0.002), and occlusion (adjOR, 34.57; 95% CI, 10.87-110.00; < 0.001)] were independently associated with the development of SPH. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.92 (95% CI, 0.87-0.95).

Conclusion: The dynamic changes in varices in SPH are long-term and slowly progressing. Males and obese patients with abnormal splenic veins and coagulopathies are at high risk for developing SPH. A simple nomogram tool helps in the early, accurate prediction of SPH.
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http://dx.doi.org/10.3389/fmed.2022.875263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9198833PMC
May 2022

Altered Gut Microbiota and Short-Chain Fatty Acids After Vonoprazan-Amoxicillin Dual Therapy for Eradication.

Front Cell Infect Microbiol 2022 2;12:881968. Epub 2022 Jun 2.

Department Of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

The combination of vonoprazan (VPZ) and amoxicillin (VA therapy) has been shown to achieve acceptable eradication rates for (). Herein, our aim was to explore the short-term effect of VA therapy on the gut microbiota and short-chain fatty acids (SCFAs) using human fecal samples. A total of 119 -positive patients were randomized into low- or high-dose VA therapy (i.e., amoxicillin 1 g b.i.d. or t.i.d. and VPZ 20 mg b.i.d.) for 7 or 10 days. Thirteen -negative patients served as controls. Fecal samples were collected from -positive and -negative patients. The gut microbiota and SCFAs were analyzed using 16S rRNA gene sequencing and gas chromatography-mass spectrometry, respectively. The gut microbiota in -positive patients exhibited increased richness, diversity, and better evenness than matched patients. Fifty-three patients studied before and after eradication were divided into low (L-VA) and high (H-VA) amoxicillin dose groups. The diversity and composition of the gut microbiota among L-VA patients exhibited no differences at the three time points. However, among H-VA patients, diversity was decreased, and the microbial composition was altered immediately after H-VA eradication but was restored by the confirmation time point. The decreased abundance of , , and induced by H-VA was associated with altered SCFA levels. VA dual therapy for eradication has minimal negative effects on gut microbiota and SCFAs.
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http://dx.doi.org/10.3389/fcimb.2022.881968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9201212PMC
June 2022

Amoxicillin-vonoprazan dual therapy for Helicobacter pylori eradication: A systematic review and meta-analysis.

J Gastroenterol Hepatol 2022 Jun 18. Epub 2022 Jun 18.

Department Of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background And Aim: The efficacy and safety of amoxicillin-vonoprazan (VA) dual therapy remained unclear.

Methods: This systematic review was conducted in accordance with the PRISMA 2009 guidelines. A systematic search of the Pubmed, Embase, and Cochrane database was conducted using the combination of "Helicobacter pylori or H. pylori or Hp," "amoxicillin or penicillin," and "Vonoprazan or TAK-438 or Takecab or (potassium AND competitive) or potassium-competitive." The initial and secondary outcome of this meta-analysis was to evaluate the efficacy and safety of VA dual therapy.

Results: Three studies and 668 H. pylori infected patients were included in this meta-analysis. The crude eradication rate of VA dual therapy was 87.5% and 89.6% by ITT and PP analysis, respectively. No significant differences were observed regarding the VA dual therapy and vonoprazan-amoxicillin-clarithromycin (VAC) triple therapy according to ITT (RR = 0.99, 95% CI, 0.93-1.05, P = 0.65) and PP (RR = 0.99, 95% CI, 0.94-1.05, P = 0.82) analysis. The side effect of VA dual therapy was 19.1% (95% CI, 5.9-32.4), which was lower than that of VAC triple therapy but there was no statistical significance (RR = 0.75, 95% CI, 0.59-1.06, P = 0.12).

Conclusion: VA dual therapy shows acceptable efficacy, good safety and avoid unnecessary antibiotic use in the first-line treatment for H. pylori infection. However, its application in other regions need to be further explored.
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http://dx.doi.org/10.1111/jgh.15917DOI Listing
June 2022

Immune enhancement in patients with predicted severe acute necrotising pancreatitis: a multicentre double-blind randomised controlled trial.

Intensive Care Med 2022 07 17;48(7):899-909. Epub 2022 Jun 17.

Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210000, Jiangsu, China.

Purpose: Infected pancreatic necrosis (IPN) is a highly morbid complication of acute necrotising pancreatitis (ANP). Since there is evidence of early-onset immunosuppression in acute pancreatitis, immune enhancement may be a therapeutic option. This trial aimed to evaluate whether early immune-enhancing Thymosin alpha 1 (Tα1) treatment reduces the incidence of IPN in patients with predicted severe ANP.

Methods: We conducted a multicentre, double-blind, randomised, placebo-controlled trial involving ANP patients with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 8 and a computed tomography (CT) severity score ≥ 5 admitted within 7 days of the advent of symptoms. Enrolled patients were assigned to receive a subcutaneous injection of Tα1 1.6 mg every 12 h for the first 7 days and 1.6 mg once a day for the subsequent 7 days or matching placebos (normal saline). The primary outcome was the development of IPN during the index admission.

Results: A total of 508 patients were randomised, of whom 254 were assigned to receive Tα1 and 254 placebo. The vast majority of the participants required admission to the intensive care unit (ICU) (479/508, 94.3%). During the index admission, 40/254(15.7%) patients in the Tα1 group developed IPN compared with 46/254 patients (18.1%) in the placebo group (difference -2.4% [95% CI - 7.4 to 5.1%]; p = 0.48). The results were similar across four predefined subgroups. There was no difference in other major complications, including new-onset organ failure (10.6% vs. 15%), bleeding (6.3% vs. 3.5%), and gastrointestinal fistula (2% vs. 2.4%).

Conclusion: The immune-enhancing Tα1 treatment of patients with predicted severe ANP did not reduce the incidence of IPN during the index admission.
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http://dx.doi.org/10.1007/s00134-022-06745-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205279PMC
July 2022

Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens.

Biomed Res Int 2022 6;2022:1915458. Epub 2022 Jun 6.

Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

Background: It was gradually accepted that endoscopic fragment biopsy (EFB) diagnosis cannot accurately guarantee the absence of higher-grade neoplasms within the lesion of the digestive tract. There are no well-established predictors for histopathologically upgrade discrepancies between EFB diagnosing colorectal low-grade intraepithelial neoplasia (LGIN) and endoscopic resection (ER) specimens.

Methods: A total of 918 colorectal LGINs was histopathologically diagnosed by EFB, including 162 cases with upgrade discrepancy and 756 concordant cases. We compared clinicopathological data of EFB and ER specimens between these two groups. Multivariate analysis was performed to identify predictors for this upgrade histopathology.

Results: The predominant upgrade discrepancy of LGINs diagnosed by EFB was upgrades to high-grade dysplasia (114/918, 12.4%), followed by upgrades to intramucosal carcinoma (33/918, 3.6%), submucosal adenocarcinoma (10/918, 1.1%), and advanced adenocarcinoma (5/918, 0.5%). NSAID history (OR 4.83; 95% CI, 2.27-10.27; < 0.001), insufficient EFB number (OR 2.99; 95% CI, 1.91-4.68; < 0.001), maximum diameter ≥ 1.0 cm (OR 6.18; 95% CI, 1.32-28.99; = 0.021), lobulated shape (OR 2.68; 95% CI, 1.65-4.36; < 0.001), erythema (OR 2.42; 95% CI, 1.50-3.91; < 0.001), erosion (OR 7.12; 95% CI, 3.91-12.94; < 0.001), surface unevenness (OR 2.31; 95% CI, 1.33-4.01; = 0.003), and distal location of the target adenoma (OR 3.29; 95% CI, 1.68-6.41; < 0.001) were associated with the histologically upgrade discrepancies.

Conclusion: NSAID history, insufficient EFB number, adenoma size and location, and abnormal macroscopic patterns are potential predictors for upgrade histopathology of LGINs diagnosed by EFBs. The standardization of EFB number and advanced imaging techniques could minimize the risk of neglecting the potential of this upgrade histopathology.
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http://dx.doi.org/10.1155/2022/1915458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9192244PMC
June 2022

Profiling Fusobacterium infection at high taxonomic resolution reveals lineage-specific correlations in colorectal cancer.

Nat Commun 2022 06 9;13(1):3336. Epub 2022 Jun 9.

Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.

The bacterial genus Fusobacterium promotes colorectal cancer (CRC) development, but an understanding of its precise composition at the species level in the human gut and the relevant association with CRC is lacking. Herein, we devise a Fusobacterium rpoB amplicon sequencing (FrpoB-seq) method that enables the differentiation of Fusobacterium species and certain subspecies in the microbiota. By applying this method to clinical tissue and faecal samples from CRC patients, we detect 62 Fusobacterium species, including 45 that were previously undescribed. We additionally reveal that Fusobacterium species may display different lineage-dependent functions in CRC. Specifically, a lineage (designated L1) including F. nucleatum, F. hwasookii, F. periodonticum and their relatives (rather than any particular species alone) is overabundant in tumour samples and faeces from CRC patients, whereas a non-enriched lineage (designated L5) represented by F. varium and F. ulcerans in tumours has a positive association with lymphovascular invasion.
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http://dx.doi.org/10.1038/s41467-022-30957-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184491PMC
June 2022

Convergent dysbiosis of gastric mucosa and fluid microbiome during stomach carcinogenesis.

Gastric Cancer 2022 Jun 4. Epub 2022 Jun 4.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.

Background: A complex microbiota in the gastric mucosa (GM) has been unveiled recently and its dysbiosis is identified to be associated with gastric cancer (GC). However, the microbial composition in gastric fluid (GF) and its correlation with GM during gastric carcinogenesis are unclear.

Methods: We obtained GM and GF samples from 180 patients, including 61 superficial gastritis (SG), 55 intestinal metaplasia (IM) and 64 GC and performed 16S rRNA gene sequencing analysis. The concentration of gastric acid and metabolite nitrite has been measured.

Results: Overall, the composition of microbiome in GM was distinct from GF with less diversity, and both were influenced by H. pylori infection. The structure of microbiota changed differentially in GM and GF across histological stages of GC, accompanied with decreased gastric acid and increased carcinogenic nitrite. The classifiers of GC based on microbial markers were identified in both GM and GF, including Lactobacillus, Veillonella, Gemella, and were further validated in an independent cohort with good performance. Interestingly, paired comparison between GM and GF showed that their compositional distinction remarkably dwindled from SG to GC, with some GF-enriched bacteria significantly increased in GM. Moreover, stronger interaction network between microbes of GM and GF was observed in GC compared to SG.

Conclusion: Our results, for the first time, revealed a comprehensive profile of both GM and GF microbiomes during the development of GC. The convergent microbial characteristics between GM and GF in GC suggest that the colonization of carcinogenic microbes in GM might derive from GF.
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http://dx.doi.org/10.1007/s10120-022-01302-zDOI Listing
June 2022

Incidence and risk factors for rebleeding after emergency endoscopic hemostasis for marginal ulcer bleeding.

Clin Res Hepatol Gastroenterol 2022 May 21;46(8):101953. Epub 2022 May 21.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China. Electronic address:

Background: Marginal ulcer bleeding is a cause of upper gastrointestinal bleeding, but the efficacy of emergency endoscopic hemostasis and risk factors for rebleeding have not been fully explored. The purpose of the current study was to investigate the rebleeding rate and risk factors after emergency endoscopic hemostasis for marginal ulcer bleeding.

Methods: We conducted a retrospective study of 105 patients who underwent emergency endoscopic hemostasis due to marginal ulcer bleeding from January 2015 to July 2021. Patients included in this study were divided into rebleeding and non-rebleeding groups.

Results: Among the 105 patients, 15.2% (16/105) patients developed rebleeding within 30 days after endoscopic hemostasis, and 87.5% of the patients had rebleeding within 7 days. The mean age of these patients was 60.3 ± 12.3 years, and 95 of them were male. In the univariate analysis, an ulcer size ≥10 mm, a PLT count <100 × 10^9/L and an AIMS65 score ≥2 were risk factors for rebleeding. According to the multivariable analysis, an ulcer size ≥10 mm (OR: 3.715; 95% CIs: 1.060-14.250; p = 0.043) and a PLT count <100 × 10^9/L (OR: 4.480; 95% CIs: 1.099-18.908; p = 0.035) were independent risk factors for rebleeding.

Conclusion: Emergency endoscopic hemostasis is an effective treatment for marginal ulcer bleeding. An ulcer size ≥10 mm and a PLT count <100 × 10^9/L were independent risk factors for rebleeding within 30 days after endoscopic hemostasis for marginal ulcer bleeding.
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http://dx.doi.org/10.1016/j.clinre.2022.101953DOI Listing
May 2022

Probiotics mitigate Helicobacter pylori-induced gastric inflammation and premalignant lesions in INS-GAS mice with the modulation of gastrointestinal microbiota.

Helicobacter 2022 Aug 9;27(4):e12898. Epub 2022 May 9.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: Dysbiosis of gastric microbiota including Helicobacter pylori (H. pylori) infection is associated with the development of stomach cancer. Probiotics have been shown to attenuate H. pylori-induced gastritis, although their role in cancer prevention remains unclear. Thus, we aimed to explore the effects of probiotics on H. pylori-induced carcinogenesis and the alterations of gastrointestinal microbiota.

Methods: Male INS-GAS mice were randomly allocated to H. pylori-infected and non-infected groups. After 4 weeks, probiotic combination (containing Lactobacillus salivarius and Lactobacillus rhamnosus) was administered in drinking water for 12 weeks. Stomachs were collected for RNA-Sequencing and the differentially expressed genes were validated using RT profiler PCR array. 16S rRNA gene sequencing was performed to assess the alterations of gastrointestinal microbiota.

Results: Probiotics significantly alleviate H. pylori-induced gastric pathology, including reduced infiltration of inflammation and lower incidence of precancerous lesions. RNA-Sequencing results showed that probiotics treatment decreased expressions of genes involved in pro-inflammatory pathways, such as NF-κB, IL-17, and TNF signaling pathway. Of note, probiotics did not suppress the growth of H. pylori, but dramatically reshaped the structure of both gastric and gut microbiota. The microbial diversity was increased in H. pylori-infected group after probiotics treatment. While gastric cancer-associated genera Lactobacillus and Staphylococcus were enriched in the stomach of H. pylori-infected group, the beneficial short-chain fatty acids-producing bacteria, including Bacteroides, Alloprevotella, and Oscellibacter, were more abundant in mice treated with probiotics. Additionally, probiotics restored the H. pylori-induced reduction of anti-inflammatory bacterium Faecalibaculum in the gut.

Conclusions: Probiotics therapy can protect against H. pylori-associated carcinogenesis probably through remodeling gastrointestinal microbiota, which in turn prevent host cells from malignant transformation.
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http://dx.doi.org/10.1111/hel.12898DOI Listing
August 2022

Optimization of vonoprazan-amoxicillin dual therapy for eradicating Helicobacter pyloriinfection in China: A prospective, randomized clinical pilot study.

Helicobacter 2022 Aug 25;27(4):e12896. Epub 2022 Apr 25.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: Vonoprazan-amoxicillin (VA) dual therapy has been shown to achieve acceptable cure rates for treatment of Helicobacter pylori(H. pylori) in Japan. Its effectiveness in other regions is unknown. We aimed to explore the efficacy of VA dual therapy as first-line treatment for H. pyloriinfection in China.

Methods: This was a single center, prospective, randomized clinical pilot study conducted in China. Treatment naive H. pyloriinfected patients were randomized to receive either low- or high-dose amoxicillin-vonoprazan consisting of amoxicillin 1 g either b.i.d. or t.i.d plus VPZ 20 mg b.i.d for 7 or 10 days. C-urea breath tests were used to access the cure rate at least 4 weeks after treatment.

Results: Three hundred and twenty-three patients were assessed, and 119 subjects were randomized. The eradication rates of b.i.d. amoxicillin for 7 and 10 days, t.i.d. amoxicillin for 7 and 10 days were 66.7% (16/24), 89.2% (33/37), 81.0% (17/21), and 81.1% (30/37) (p = .191) by intention-to-treat analysis, respectively, and 72.7% (16/22), 89.2% (33/37), 81.0% (17/21), and 81.1% (30/37) (p = .454) by per-protocol analysis, respectively.

Conclusion: Neither 7- or 10-day VA dual therapy with b.i.d. or t.i.d. amoxicillin provides satisfied efficacy as the first-line treatment for H. pyloriinfection in China. Further optimization is needed.
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http://dx.doi.org/10.1111/hel.12896DOI Listing
August 2022

Potential Roles of the Gut Microbiota in Pancreatic Carcinogenesis and Therapeutics.

Front Cell Infect Microbiol 2022 6;12:872019. Epub 2022 Apr 6.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China.

The intestinal microenvironment is composed of normal gut microbiota and the environment in which it lives. The largest microecosystem in the human body is the gut microbiota, which is closely related to various diseases of the human body. Pancreatic cancer (PC) is a common malignancy of the digestive system worldwide, and it has a 5-year survival rate of only 5%. Early diagnosis of pancreatic cancer is difficult, so most patients have missed their best opportunity for surgery at the time of diagnosis. However, the etiology is not entirely clear, but there are certain associations between PC and diet, lifestyle, obesity, diabetes and chronic pancreatitis. Many studies have shown that the translocation of the gut microbiota, microbiota dysbiosis, imbalance of the oral microbiota, the interference of normal metabolism function and toxic metabolite products are closely associated with the incidence of PC and influence its prognosis. Therefore, understanding the correlation between the gut microbiota and PC could aid the diagnosis and treatment of PC. Here, we review the correlation between the gut microbiota and PC and the research progresses for the gut microbiota in the diagnosis and treatment of PC.
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http://dx.doi.org/10.3389/fcimb.2022.872019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9019584PMC
April 2022

Aromatic profiles and enantiomeric distributions of chiral odorants in baked green teas with different picking tenderness.

Food Chem 2022 Sep 12;388:132969. Epub 2022 Apr 12.

Key Laboratory of Tea Biology and Resource Untilization, Ministry of Agriculture, Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou 310008, China. Electronic address:

Suitable picking tenderness is an essential prerequisite for manufacturing tea. However, the influence of picking tenderness of fresh tea leaves on the aromatic components is still unclear. In this study, aromatic profiles and chiral odorants in fresh tea leaves and corresponding baked green teas with five levels of tenderness of two representative cultivars were analysed using stir bar sorptive extraction-gas chromatography-mass spectrometry. cis-Linalool oxide (furanoid) and methyl salicylate exhibited significantly increasing trends as samples of all series matured. The content of most chiral odorants was significantly high in the mature samples, and significant content variations of all enantiomers during baked green tea processing could be observed with different trends according to their precursors. In particular, the enantiomeric ratios of most chiral odorants were less influenced by the picking tenderness and processing, while drying (limonene), spreading and fixation (α-terpineol), and spreading (dihydroactinidiolide) influenced the chiral distribution of the aforementioned odorants.
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http://dx.doi.org/10.1016/j.foodchem.2022.132969DOI Listing
September 2022

Phase-Selective Synthesis of Ruthenium Phosphide in Hybrid Structure Enables Efficient Hybrid Water Electrolysis Under pH-Universal Conditions.

Small 2022 05 17;18(20):e2200242. Epub 2022 Apr 17.

Hefei National Research Center for Physical Sciences at the Microscale, CAS Key Laboratory of Materials for Energy Conversion, Department of Materials Science and Engineering, University of Science and Technology of China, Hefei, Anhui, 230026, China.

Hydrazine-assisted hybrid water electrolysis is an energy-saving approach to produce high-purity hydrogen, whereas the development of pH-universal bifunctional catalysts encounters a grand challenge. Herein, a phase-selective synthesis of ruthenium phosphide compounds hybrid with carbon forming pancake-like particles (denoted as Ru P/C-PAN, x = 1 or 2) is presented. The obtained RuP/C-PAN exhibits the highest catalytic activity among the control samples, delivering ultralow cell voltages of 0.03, 0.27, and 0.65 V to drive 10 mA cm using hybrid water electrolysis corresponding to pH values of 14, 7, and 0, respectively. Theoretical calculation deciphers that the RuP phase displays optimized free energy for hydrogen adsorption and reduced energy barrier for hydrazine dehydrogenation. This work may not only open up a new avenue in exploring universally compatible catalyst to transcend the limitation on the pH value of electrolytes, but also push forward the development of an energy-saving hydrogen generation technique based on emerging hybrid water electrolysis.
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http://dx.doi.org/10.1002/smll.202200242DOI Listing
May 2022

Exposure assessment and risk-based limit levels evaluation of ochratoxin A in Astragali Radix in China.

Ecotoxicol Environ Saf 2022 Jun 13;237:113517. Epub 2022 Apr 13.

Yangtze Delta Region Institute of Tsinghua University, Zhejiang 314006, China. Electronic address:

Ochratoxin A (OTA) is a mycotoxin found in a variety of foods and herbal medicines, and several governmental bodies around the world have set maximum allowable levels of OTA in different foods and herbal medicines. This study aims to evaluate the health risk of OTA in Astragali Radix (AR) in China, and to evaluate the effects of different limit levels on the risk control of OTA in AR. The concentrations of OTA in 187 samples of AR were investigated, and 61 (32.6%) samples were positive. The mean, 50th and 95th percentile values of OTA in positive samples were 56.2, 5.1 and 304.5 μg/kg, respectively. A margin of exposure (MOE) approach was applied to assess the risk. Considering other food sources, long-term consumers have a relatively high risk of OTA exposure due to the ingestion of AR. Theoretical limit levels of OTA in AR were evaluated from two dimensions by weighing the costs and the benefits. The results indicated that the limit levels that might be applied to the management of OTA contamination in AR in China could be screened out through risk-based evaluation of limit levels.
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http://dx.doi.org/10.1016/j.ecoenv.2022.113517DOI Listing
June 2022

Susceptibility-Guided Therapy vs. Bismuth-Containing Quadruple Therapy as the First-Line Treatment for Infection: A Systematic Review and Meta-Analysis.

Front Med (Lausanne) 2022 24;9:844915. Epub 2022 Mar 24.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: The increased antibiotic resistance of () has led to the decreased efficacy of regimens.

Aim: To evaluate the efficacy, safety, and compliance of susceptibility-guided therapy (SGT) vs. bismuth-containing quadruple therapy (BQT) as the first-line treatment for infection.

Materials And Methods: This meta-analysis was performed in accordance with the PRISMA 2009 guidelines. A systematic search in PubMed, Embase, and Cochrane databases was conducted using the combination of " or or ," "bismuth quadruple," and "tailored eradication OR tailored therapy OR susceptibility-guided therapy OR personalized therapy OR antibiotic susceptibility testing."

Results: Five studies with 2,110 infected patients were enrolled. The pooled eradication rates of SGT and BQT were 86 vs. 78% ( < 0.05) and 92 vs. 86% ( > 0.05) by intention-to-treat (ITT) and per-protocol (PP) analyses, respectively. SGT has a significantly superior efficacy than BQT [pooled risk ratio (RR) = 1.14, < 0.05] in a subgroup of cultures with the susceptibility test. The pooled side effect rate was 20% in SGT and 22% in BQT, which showed no significant difference ( > 0.05). The compliances of SGT and BQT were 95 and 92%, respectively.

Conclusion: Compared with BQT, SGT showed a higher efficacy and similar safety as the first-line treatment of infection in areas with high antibiotic resistance. The decision-making of first-line regimens for infection should depend on the availability and cost-effectiveness of susceptibility tests and bismuth in local areas.
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http://dx.doi.org/10.3389/fmed.2022.844915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987208PMC
March 2022

Diagnosis and treatment of Helicobacter pylori infection by physicians in China: A nationwide cross-sectional study.

Helicobacter 2022 Jun 1;27(3):e12889. Epub 2022 Apr 1.

Department of Gastroenterology, Haikou People's Hospital, Haikou, Hainan, China.

Background: To investigate the current state of knowledge and practice of Helicobacter pylori (H. pylori) infection management in China.

Materials And Methods: This nationwide, multicenter, cross-sectional questionnaire survey was conducted between March and April 2021 with respect to the diagnosis and treatment of H. pylori infection in 31 provinces, encompassing over 1000 hospitals in mainland China. General physician information, diagnostic and detection status, eradication treatment, reexamination and follow-up after treatment, and basic knowledge of physicians were collected and compared with the Fifth Chinese National Consensus Report on Management of H. pylori infection and the 2016 Maastricht V/Florence guidelines. The subgroup analysis was also performed.

Results: Of the 6873 questionnaire respondents, 48.8% were males, and 51.2% were females. Approximately, 26.5% of respondents indicated that their hospitals had dedicated clinics for managing H. pylori infection. Moreover, 88.0% of respondents prescribed a bismuth-containing quadruple regimen as the initial eradication treatment, and 92.7% deemed the gastric acid suppression critical. Furthermore, 91.0% of respondents routinely recommended a reexamination 1-2 months after eradication therapy, and 95.1% advised patients to stop PPI treatment at least 2 weeks before reexamination. The detail of following (the choice of target population/methods; the choice/availability of drugs/regimens, indications for eradication, factors influencing eradication efficacy/improvement methods and factors influencing adherence, management options/factors influencing relapse; the timing and methods, awareness of reinfection rates/prevention measures, and the approach to continuing education, awareness of guidelines, and acceptance of current core concepts of management) was also described. Subgroup analysis further revealed that significant differences were existed in being gastroenterologist or not, different education level, professional title, years of working, and provincial administrative regions.

Conclusions: Chinese physicians' skills and knowledge about the diagnosis and treatment of H. pylori infection could be improved. More works on education are needed in future.
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http://dx.doi.org/10.1111/hel.12889DOI Listing
June 2022

Alterations of Gut Mycobiota Profiles in Adenoma and Colorectal Cancer.

Front Cell Infect Microbiol 2022 24;12:839435. Epub 2022 Feb 24.

Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

Accumulating evidence indicates that gut microbiota dysbiosis contributes to colorectal cancer and adenoma. However, a few studies revealed the altered gut mycobiota architecture in colorectal cancer. The present study characterized the gut mycobiota profiles in adenoma and colorectal cancer patients by metagenomic sequencing. increased, while and significantly decreased in adenoma. , , and were the top 3 fungi that were significantly enriched in colorectal cancer, while , , and were dominant in the healthy controls. Thirteen fungi, ranked as critical biomarkers in diagnosing colorectal cancer, showed positive associations among all samples. and showed the most significant association within CRC. The values of area under the receiver-operating characteristics curve (AUROC) of selected 13 mycobiota were 0.926 in the training model and 0.757 in the 10-fold validation model. Our study provided a reliable investigation of the alterations of gut mycobiota in the development of colorectal cancer and established a convincing diagnostic model for colorectal cancer, which might improve the treatment strategy for colorectal cancer in the future.
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http://dx.doi.org/10.3389/fcimb.2022.839435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8908310PMC
April 2022

The Value of Serum Tumor Markers and Blood Inflammation Markers in Differentiating Pancreatic Serous Cystic Neoplasms and Pancreatic Mucinous Cystic Neoplasms.

Front Oncol 2022 25;12:831355. Epub 2022 Feb 25.

The First Affiliated Hospital of Nanchang University, Nanchang, China.

Although many studies have emphasized the prognostic and diagnostic value of tumor markers and various inflammation-related markers, their clinical significance in differentiating benign and malignant pancreatic cystic neoplasms (PCNs) remains to be clarified. The present study explored the value of serum tumor markers and inflammation-related biomarkers in the differentiation of pancreatic serous cystic neoplasms (SCNs) and pancreatic mucinous cystic neoplasms (MCNs). A total of 79 patients with PCNs were included in this study, including 35 patients with SCNs and 44 patients with MCNs. Comparison of baseline data with preoperative results of serum tumor markers and associated inflammatory markers revealed significant differences in carbohydrate antigen 199 (CA199) and "lymphocyte × ALB" (LA) between the two groups (p = 0.0023, p = 0.0149, respectively). Univariate and multivariate regression analyses showed that an increase in CA199 and a decrease in LA were relevant risk factors for MCNs. Finally, the receiver operating characteristic (ROC) curve was generated, and the area under the ROC curve (AUC) was calculated to evaluate the prediction efficiency of each indicator. The results showed that CA199 and LA had good differential diagnostic efficacy for SCNs and MCNs. This is the first to report to demonstrate that LA can be used for the differential diagnosis of SNCs and MCNs.
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http://dx.doi.org/10.3389/fonc.2022.831355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8913928PMC
February 2022

Risk Factors for Fever After Esophageal Endoscopic Submucosal Dissection and Its Derived Technique.

Front Med (Lausanne) 2022 22;9:713211. Epub 2022 Feb 22.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: Fever is one of the postoperative adverse events of endoscopic submucosal dissection and its derived technique, but the probability and risk factors of postoperative fever are still unclear. The aim of the current study was to investigate the incidence and risk factors of postoperative fever after esophageal lesion removal.

Methods: We conducted a retrospective study of 446 patients who underwent esophageal endoscopic submucosal dissection and its derived technique between January 2014 and January 2020. Cases included in this study were divided into fever and non-fever groups.

Results: Postoperative fever developed in 135 patients (30.3%). The median (range) highest fever temperature was 38 (37.8-38.4)°C, the median (range) duration of fever was 1 (1-2) day, and 127 (94.1%) patients developed fever within 24 h after operation. Through logistic regression analysis, factors associated with postoperative fever were age (OR: 1.740, 95% CI: 1.005-3.013, = 0.048), lesion size (OR: 2.007, 95% CI: 1.198-3.362, = 0.008), operation time (OR: 3.007, 95% CI: 1.756-5.147, < 0.001) and nasogastric tube placement (OR: 1.881, 95% CI: 1.165-3.037, = 0.010), while prophylactic antibiotics (OR: 0.181, 95% CI: 0.082-0.401, < 0.001) were negatively associated with fever.

Conclusions: Age ≥52 years old, lesion size ≥19 mm, operation time ≥37 min, and nasogastric tube placement are risk factors for postoperative fever after esophageal endoscopic submucosal dissection and its derived technique, prophylactic antibiotic use after operation may help reduce fever rate. Attention should be paid to such patients to minimize the risk of postoperative fever.
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http://dx.doi.org/10.3389/fmed.2022.713211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8902360PMC
February 2022

Randomized controlled trial: neostigmine for intra-abdominal hypertension in acute pancreatitis.

Crit Care 2022 03 3;26(1):52. Epub 2022 Mar 3.

Pancreatic Intensive Care Unit, Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, China.

Background: Intra-abdominal hypertension (IAH) in acute pancreatitis (AP) is associated with deterioration in organ function. This trial aimed to assess the efficacy of neostigmine for IAH in patients with AP.

Methods: In this single-center, randomized trial, consenting patients with IAH within 2 weeks of AP onset received conventional treatment for 24 h. Patients with sustained intra-abdominal pressure (IAP) ≥ 12 mmHg were randomized to receive intramuscular neostigmine (1 mg every 12 h increased to every 8 h or every 6 h, depending on response) or continue conventional treatment for 7 days. The primary outcome was the percent change of IAP at 24 h after randomization.

Results: A total of 80 patients were recruited to neostigmine (n = 40) or conventional treatment (n = 40). There was no significant difference in baseline parameters. The rate of decrease in IAP was significantly faster in the neostigmine group compared to the conventional group by 24 h (median with 25th-75th percentile: -18.7% [- 28.4 to - 4.7%] vs. - 5.4% [- 18.0% to 0], P = 0.017). This effect was more pronounced in patients with baseline IAP ≥ 15 mmHg (P = 0.018). Per-protocol analysis confirmed these results (P = 0.03). Stool volume was consistently higher in the neostigmine group during the 7-day observational period (all P < 0.05). Other secondary outcomes were not significantly different between neostigmine and conventional treatment groups.

Conclusion: Neostigmine reduced IAP and promoted defecation in patients with AP and IAH. These results warrant a larger, placebo-controlled, double-blind phase III trial. Trial registration Clinical Trial No: NCT02543658 (registered August /27, 2015).
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http://dx.doi.org/10.1186/s13054-022-03922-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892692PMC
March 2022

Lactobacillus rhamnosus GG combined with inosine ameliorates alcohol-induced liver injury through regulation of intestinal barrier and Treg/Th1 cells.

Toxicol Appl Pharmacol 2022 03 15;439:115923. Epub 2022 Feb 15.

Department of Infectious Diseases and liver Diseases, Ningbo Medical Centre Lihuili Hospital, Affiliated Lihuili Hospital of Ningbo University, Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo 315040, China; Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory for Accurate Diagnosis and Treatment of Chronic Liver Diseases, Hepatology Institute of Wenzhou Medical University, Wenzhou 325025, China. Electronic address:

Background: Intestinal epithelial barrier disruption and bacterial translocation exacerbates the progression of alcoholic liver disease. Lactobacillus rhamnosus GG (LGG), a probiotic, has been shown benefits in chronic liver disease and in regulating gut dysbiosis. Previous studies showed the protective roles of LGG in ethanol-disrupted gut barrier functions and liver injury. Inosine, a metabolite produced by intestinal bacteria, has the anti-inflammatory and immunregulatory functions. In this study, the synergistic effect of LGG and inosine was investigated in a mouse model of alcohol-induced liver disease (ALD).

Methods: Male C57BL/6 mice were fed with a Lieber-DeCarli diet containing 5% alcohol for four weeks to establish a model of alcohol-induced liver injury. LGG or a combination of LGG and inosine were administrated orally to explore a new therapeutic method for alcohol-induced liver disease and to investigate the underlying mechanisms. Liver damage was evaluated by transaminases and pathological changes. Tight junction proteins, composition of the gut microbiome, cytokines, lipopolysaccharides (LPS), glutathione (GSH), superoxide dismutase (SOD), malondialdehyde (MDA), F4/80+ macrophages, as well as p38, Jun N-terminal kinase (JNK), were determined by qRT-PCR, RNAseq, ELISA, IHC and western blot. Regulatory T (Treg) cells were characterized by positive staining of CD4, CD25 and Foxp3 using flow cytometry. IFN-γ-producing CD4 T (Th1) cells were examined by intracellular cytokine staining.

Results: Alcohol consumption induced elevated liver enzymes, steatosis and inflammation, while LGG combined with inosine treatment was more significant to ameliorate these symptoms compared with LGG alone. When LGG combined with inosine were administered to ALD mice, intestinal microecology significantly improved reflected by intestinal villi and tight junction proteins recovery and the restoration of intestinal flora. Combined therapy inhibited phosphorylation of p38 and JNK to alleviate hepatic inflammation. Moreover, flow cytometry analysis showed that long-term excessive alcohol consumption reduced Tregs population while increased Th1 population, which was restored by a combination of LGG and inosine treatment.

Conclusions: The findings from the study indicate that the combined LGG and inosine treatment ameliorates ALD by improving the gut ecosystem, intestinal barrier function, immune homeostasis and liver injury.
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http://dx.doi.org/10.1016/j.taap.2022.115923DOI Listing
March 2022

Development and validation of a model to predict rebleeding within three days after endoscopic hemostasis for high-risk peptic ulcer bleeding.

BMC Gastroenterol 2022 Feb 14;22(1):64. Epub 2022 Feb 14.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi Province, China.

Background: Peptic ulcer bleeding remains a typical medical emergency with significant morbidity and mortality. Peptic ulcer rebleeding often occurs within three days after emergent endoscopic hemostasis. Our study aims to develop a nomogram to predict rebleeding within three days after emergent endoscopic hemostasis for high-risk peptic ulcer bleeding.

Methods: We retrospectively reviewed the data of 386 patients with bleeding ulcers and high-risk stigmata who underwent emergent endoscopic hemostasis between March 2014 and October 2018. The least absolute shrinkage and selection operator method was used to identify predictors. The model was displayed as a nomogram. Internal validation was carried out using bootstrapping. The model was evaluated using the calibration plot, decision-curve analyses, and clinical impact curve.

Results: Overall, 386 patients meeting the inclusion criteria were enrolled, with 48 patients developed rebleeding within three days after initial endoscopic hemostasis. Predictors contained in the nomogram included albumin, prothrombin time, shock, haematemesis/melena and Forrest classification. The model showed good discrimination and good calibration with a C-index of 0.854 (C-index: 0.830 via bootstrapping validation). Decision-curve analyses and clinical impact curve also demonstrated that it was clinically valuable.

Conclusion: This study presents a nomogram that incorporates clinical, laboratory, and endoscopic features, effectively predicting rebleeding within three days after emergent endoscopic hemostasis and identifying high-risk rebleeding patients with peptic ulcer bleeding. Trial registration This clinical trial has been registered in the ClinicalTrials.gov (ID: NCT04895904) approved by the International Committee of Medical Journal Editors (ICMJE).
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http://dx.doi.org/10.1186/s12876-022-02145-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843020PMC
February 2022

Controlled attenuation parameter in the diagnosis of different liver steatosis groups in children with obesity.

Pediatr Obes 2022 06 28;17(6):e12893. Epub 2022 Jan 28.

The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.

Objective: To investigate the utility of the controlled attenuation parameter (CAP), as measured by a liver elastography technique, in predicting varying degrees of liver steatosis in children with obesity.

Methods: Children with obesity attending the pediatric obesity clinic at the Affiliated Hospital of Hangzhou Normal University from July 2020 to May 2021 were retrospectively analysed. The 71 subjects were divided into four groups according to the degree of liver steatosis obtained by magnetic resonance imaging-proton density fat fraction (MRI-PDFF). The gender, age, CAP, LSM, ALT, AST, BMI, uric acid, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, insulin, and blood 25-hydroxyvitamin D levels of the four groups were compared, and the differences were analysed. Clinical data with significant differences were included in the logistic regression analysis. The receiver operating characteristic (ROC) curve for the CAP for the 71 subjects with different degrees of liver steatosis was plotted to evaluate the diagnostic value.

Results: The 71 children were divided into groups according to the degree of hepatic steatosis obtained by MRI-PDFF, and the clinical data for each group were compared. It was found that there was statistical significance for CAP, ALT, and AST in cases of moderate and severe hepatic steatosis (p < 0.05). Logistic regression analysis was conducted between CAP, ALT, AST, and moderate to severe hepatic steatosis in children with obesity, and it was found that CAP was a factor related to moderate to severe hepatic steatosis in children with obesity. The ROC curve indicated that CAP has diagnostic value for NAFLD in children with obesity.

Conclusion: There is diagnostic value in the use of CAP for hepatic steatosis in children with obesity, and there is greater diagnostic value in the use of CAP for children with moderate to severe hepatic steatosis.
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http://dx.doi.org/10.1111/ijpo.12893DOI Listing
June 2022

Efficacy and Safety of Faecal Microbiota Transplantation for Acute Pancreatitis: A Randomised, Controlled Study.

Front Med (Lausanne) 2021 10;8:772454. Epub 2022 Jan 10.

Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.

We investigated whether faecal microbiota transplantation (FMT) decreases intra-abdominal pressure (IAP) and improves gastrointestinal (GI) dysfunction and infectious complications in acute pancreatitis (AP). In this first randomised, single-blind, parallel-group, controlled study, we recruited and enrolled consecutive patients with AP complicated with GI dysfunction. Eligible participants were randomly assigned to receive faecal transplant ( = 30) or normal saline ( = 30) via a nasoduodenal tube once and then again 2 days later. The primary endpoint was the rate of IAP decline; secondary endpoints were GI function, infectious complications, organ failure, hospital stay and mortality. Analyses were based on intention to treat. We enrolled 60 participants and randomly assigned them to the FMT ( = 30) or control ( = 30) group. Baseline characteristics and disease severity were similar for both groups. IAP decreased significantly 1 week after intervention in both groups, with no difference in the IAP decline rate between FMT and Control group [0.1 (-0.6, 0.5) vs. 0.2 (-0.2, 0.6); = 0.27]. Normal gastrointestinal failure (GIF) scores were achieved in 12 (40%) patients in the FMT group and 14 (47%) in the control group, with no significant difference ( = 0.60). However, D-lactate was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [-0.3 (-3.7, 0.8) vs. 0.4 (-1.1, 0.9); = 0.01]. Infectious complications occurred in 15 (50%) and 16 (53.33%) patients in the FMT and control groups, respectively ( = 0.80). However, interleukin-6 (IL-6) was significantly elevated in the FMT group compared to the control group, as calculated by the rate of decline [0.4 (-3.6, 0.9) vs. 0.8 (-1.7, 1.0); = 0.03]. One participant experienced transient nausea immediately after FMT, but no serious adverse events were attributed to FMT. FMT had no obvious effect on IAP and infectious complications in AP patients, though GI barrier indictors might be adversely affected. Further multi-centre studies are needed to confirm our findings. The study was registered at https://clinicaltrials.gov (NCT02318134).
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http://dx.doi.org/10.3389/fmed.2021.772454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8784600PMC
January 2022

Association between morphological features of necrotizing pancreatitis on endoscopic ultrasound and outcomes of the endoscopic transmural step-up approach.

J Dig Dis 2022 Mar 28;23(3):174-182. Epub 2022 Feb 28.

Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.

Objective: To investigate the association between necrotic collections on endoscopic ultrasound (EUS) and outcomes of the endoscopic transmural step-up approach in necrotizing pancreatitis (NP).

Methods: Adult NP patients who had undergone endoscopic transmural step-up approach, endoscopic transmural drainage or endoscopic transmural necrosectomy, were retrospectively enrolled, and divided into groups 1, 2 and 3 based on the amount of solid necrotic debris (quantified as a percentage of the total collection size of <30%, 30%-50%, and >50%).

Results: A total of 134 patients were included, of whom 52, 59 and 23 patients were categorized into groups 1, 2 and 3. Patients with more solid necrotic debris required more necrosectomy sessions (group 3 vs group 2 vs group 1: 2.0 vs 1.0 vs 1.0, P < 0.001), were more likely to experience stent occlusion (group 3 vs group 2 vs group 1: 34.8% vs 16.9% vs 9.6%, P = 0.011), and had a longer hospitalization (group 3 vs group 2 vs group 1: 40.0 d vs 28.0 d vs 25.5 d, P = 0.015). High procalcitonin level (adjusted odds ratio [aOR] 6.14, 95% confidence interval [CI] 1.40-26.94, P = 0.016) and any organ failure (aOR 11.51, 95% CI 2.42-54.78, P = 0.002) were independently associated with clinical failure of endoscopic transmural step-up approach.

Conclusions: More solid necrotic debris on EUS is related to more necrosectomy sessions, higher incidence of stent occlusion and longer hospitalization. A nomogram combining procalcitonin and any organ failure performs well in predicting clinical failure of endoscopic transmural step-up approach.
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http://dx.doi.org/10.1111/1751-2980.13083DOI Listing
March 2022
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