简介：Medicaltherapyfortype2diabetesmellitusisineffectiveinthelongtermduetotheprogressivenatureofthedisease,whichrequiresincreasingmedicationdosesandpolypharmacy.Conversely,bariatricsurgeryhasemergedasacost-effectivestrategyforobesediabeticindividuals;ithaslowcomplicationratesandresultsindurableweightloss,glycemiccontrolandimprovementsinthequalityoflife,obesity-relatedco-morbidityandoverallsurvival.Thefindingthatglucosehomeostasiscanbeachievedwithaweightloss-independentmechanismimmediatelyafterbariatricsurgery,especiallygastricbypass,hasledtotheparadigmofmetabolicsurgery.However,theprimaryfocusofmetabolicsurgeryisthealterationofthephysio-anatomyofthegastrointestinaltracttoachieveglycemiccontrol,metaboliccontrolandcardio-metabolicriskreduction.Todate,metabolicsurgeryisstillnotwelldefined,asitisusedmostfrequentlyforlessobesepatientswithpoorlycontrolleddiabetes.Themechanismofglycemiccontrolisstillincompletelyunderstood.Publishedresearchfindingsonmetabolicsurgeryarepromising,butmanyaspectsstillneedtobedefined.Thispaperexaminestheproposedmechanismofdiabetesremission,theefficacyofdifferenttypesofmetabolicprocedures,thedurabilityofglucosecontrol,andtherisksandcomplicationsassociatedwiththisprocedure.Weproposeatailoredapproachfortheselectionoftheidealmetabolicprocedurefordifferentgroupsofpatients,consideringtheindicationsandprognosticfactorsfordiabetesremission.

简介：Gastrointestinal(GI)cancerisoneofthemostcommoncausesofcancer-relateddeathsworldwide.Tumormarkersarevaluableindetectingpost-surgicalrecurrenceorinmonitoringresponsetochemotherapy.PyruvatekinaseisoformM2(PKM2),aglycolyticenzymecatalyzingconversionofphosphoenolpyruvate(PEP)topyruvate,confersagrowthadvantagetothetumorcellsandenablesthemtoadapttothetumormicroenvironment.Inthisreview,wehavesummarizedcurrentresearchontheexpressionandregulationofPKM2intumorcells,anditspotentialroleinGIcarcinogenesisandprogression.Furthermore,wehavealsodiscussedthepotentialofPKM2asadiagnosticandscreeningmarker,andatherapeutictargetinGIcancer.

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简介：AbstractArtificial intelligence (AI) is now a trendy subject in clinical medicine and especially in gastrointestinal (GI) endoscopy. AI has the potential to improve the quality of GI endoscopy at all levels. It will compensate for humans’ errors and limited capabilities by bringing more accuracy, consistency, and higher speed, making endoscopic procedures more efficient and of higher quality. AI showed great results in diagnostic and therapeutic endoscopy in all parts of the GI tract. More studies are still needed before the introduction of this new technology in our daily practice and clinical guidelines. Furthermore, ethical clearance and new legislations might be needed. In conclusion, the introduction of AI will be a big breakthrough in the field of GI endoscopy in the upcoming years. It has the potential to bring major improvements to GI endoscopy at all levels.

简介：ComparisonsintheratesofstomachandcoloncancerbetweencountriesoftheEastandthoseoftheWestsuggestthatdietaryfactorsplayasignificantroleincarcinogenesisofthegastrointestinaltract.However,ithasbeendifficulttoclarifywhichofthemanyfactorsthatinfluencecarcinogenesisareinfactalteredbydiet.Geneticdeterminants,dietaryhabits,

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简介：胃的胃肠的stromal肿瘤的stagesIandIII之间的差别主要取决于有丝分裂的数字。与TNM分类，在高有丝分裂的率的肿瘤的存在决定升级。许多研究在评估有丝分裂的数字暴露了不同计数技术。估计有丝分裂的率的一个国际标准化方法被需要。

简介：Theperitonealstromaltissuewhichprovidesarichsourceofgrowthfactorsandchemokinesisafavorableenvironmentfortumorproliferation.Thepathophysiologicalmechanismofperitonealcarcinomatosisisanindividualsequenceconsistingofgeneticandenvironmentalfactorsandremainscontroversial.Thenaturalhistoryofthediseaserevealsapoormedianprognosisofapproximately6mo;howeveraggressivesurgeryandmultimodaltreatmentoptionscanimproveoncologicoutcomes.Consideringperitonealcarcinomatosisasthoughitisalocoregionaldiseasebutnotametastaticprocess,cytoreductivesurgeryandandintraperitonealchemotherapyhasbeenacurativeoptionduringrecentyears.Cytoreductivesurgeryimpliesaseriesofvisceralresectionsandperitonectomyprocedures.Althoughtheaimofcytoreductivesurgeryistoeliminateallmacroscopicdisease,viabletumorcellsmayremainintheperitonealcavity.Atthatpoint,intraperitonealchemotherapycanextendthemacroscopicdiseaseeliminationtomicroscopicdiseaseelimination.Thesuccessfultreatmentofperitonealcarcinomatosisrequiresacomprehensivemanagementplanincludingproperpatientselection,completeresectionofallvisibledisease,perioperativeintraperitonealchemotherapyandpostoperativesystemicchemotherapy.Surgicalandoncologicoutcomesarestrictlyassociatedwithextentofthetumor,completenessofcytoreductionandpatientrelatedfactorsaswellasmultidisciplinarymanagementandexperienceofthesurgicalteam.Inthisreview,pathophysiologyandcurrentmanagementofperitonealcarcinomatosisoriginatingfromgastrointestinaltumorsarediscussedaccordingtothelatestliterature.

简介：Inthecomingyearslifeexpectancyisexpectedtoincreaseandwiththisthepercentageofthepopulationaboveage65willgrow.Patientsabove65makeupmorethantwothirdsofthosecurrentlydiagnosedwithgastrointestinalmalignancies.Availableevidencebasedmedicinedoesnotfocusontheaveragepatient,abovetheage70,encounteredineverydaypractice.Mostguidelinesandclinicaltrialsarenotdesignedtotakeintoaccountthespecialconsiderationsneededwhentreatingtheelderlysuchasfunctionalstatus,comorbidities,polypharmacy,lifeexpectancy,andsocialsupport.Themajorityofavailabledataisbasedonretrospectivereviewsorsubsetanalysesoflargerstudieswheretheelderlyrepresentafractionofthestudiedpopulation.Thisreviewfocusesonthetoxicitiesandtolerabilityofcurrentstandardtherapiesfornoncolorectalgastrointestinalmalignancies,includinggastroesophageal,pancreatic,bileductandhepatocellularcancersintheelderly.Withcarefulpatientselectionandgeriatricassessmenttheelderlycansafelybenefitfromstandardtherapiesofferedtoyoungerpatients.

简介：AIM:Todiscusstheclinicalsignificanceofpostoperativegastrointestinaldecompressioninoperationonlowerdigestivetract.METHODS:Threehundredandsixty-eightpatientswithexcisionandanastomosisoflowerdigestivetractweredividedintotwogroups,i.e.thegroupwithpostoperativegastrointestinaldecompressionandthegroupwithoutpostoperativegastrointestinaldecompression.Clinicaltherapeuticoutcomeandincidenceofcomplicationwerecomparedbetweentwogroups.Furthermore,aninvestigationonapplicationofgastrointestinaldecompressionwascarriedoutamong200generalsurgeons.RESULTS:Thevolumeofgastricjuiceindecompressiongroupwasabout200mLeverydayafteroperation.Bothgroupshadalowergirthbeforeoperationthaneverydayafteroperation.Nodifferenceinlengthofthefirstpassageofgasbyanusanddefecationafteroperationwasfoundbetweentwogroups.Theoverallincidenceofcomplicationswasobviouslyhigherindecompressiongroupthaninnon-decompressiongroup(28%vs8.2%,P<0.001).Theincidenceofpharyngolaryngitiswasupto23.1%.Therewasalsonodifferencebetweentwogroupsregardingthelengthofhospitalizationafteroperation.Themajority(97.5%)ofgeneralsurgeonsheldthatgastrointestinaldecompressionshouldbeplacedtillpassageofgasbyanus,andonly2.5%ofsurgeonsthoughtthatgastrointestinaldecompressionshouldbeplacedfor2-3dbeforepassageofgasbyanus.Nobody(0%)deemeditunnecessaryforplacinggastrointestinalcompressionafteroperation.CONCLUSION:Applicationofgastrointestinaldecompressionafterexcisionandanastomosisoflowerdigestivetractcannoteffectivelyreducegastrointestinaltractpressureandhasnoobviouseffectonpreventingpostoperativecomplications.Onthecontrary,itmayincreasetheincidenceofpharyngolaryngitisandothercomplications.Therefore,itismorebeneficialtotherecoveryofpatientswithoutundergoinggastrointestinaldecompression.

简介：客观直到最近胃肠的基质肿瘤(大意)与另外的间充质的瘤被分开了；作为一个特殊实体分类。肿瘤房间的形态学；免疫有CD117的组织化学的调查结果在大意的病理学的诊断是关键的。最新发达的药imatinibmesylate(先前叫的STI571)为大意被证明有效。大意的区别；另外的间充质的肿瘤有大临床的意义，特别为位于直肠肛门的损害。作者寻找了北京大学的数据库的方法，为有肛门直肠的瘤的病人的肿瘤学的学校从1995年1月对待到2002年6月。有肛门直肠的间充质的肿瘤的12个病人的信息是镇定的。病人被重新估计；与临床的数据根据电流讨论了大意的标准；免疫组织化学的调查结果。结果六个病人(包括3男性)最后作为肛门直肠的大意被诊断。那些病人的中部的年龄是59.5年(27～69)。症状不是特定的。有平滑肌瘤或平滑肌肉瘤的原来的诊断的三个盒子实际上是大意。六肛门直肠的大意的一个总数被发现作为在一样的时期与肛门直肠的瘤包括大约1.06%病人。除CD117以外，CD34；vimentin也在这些病人的多数被表示。六个病人中的五个经历了其一在切除术前收到了neoadjuvant化疗的外科的切除术。结论肛门直肠的大意应该用当前的诊断标准被看作一个特殊实体。外科的切除术仍然是主要治疗学的策略。Neoadjuvantimatinibmesylate可能在括约肌圆材操作是有用的；为这些病人的生命的质量的改进。

简介：Inordertofurtherpromotethestandardizationofdiagnosisandtreatmentofgastrointestinalstromaltumor(GIST)inChina,themembersofChineseSocietyofClinicalOncology(CSCO)ExpertCommitteeonGISTthoroughlydiscussedthekeycontentsoftheconsensusguidelines,andvotedonthecontroversialissue.Infinal,theChineseconsensusguidelinesforthediagnosisandmanagementofGIST(2017edition)wasformedonthebasisof2013editionconsensusguidelines,whichisherebyannounced.Theconsensusincludedthepathologicaldiagnosis,recurrenceriskclassificationevaluation,targetedagenttherapy,surgeryandprinciplesofsurveillanceofGIST.

简介：瞄准：与胃肠的graft-versus-host疾病(官方补给的GVHD)在病人评估内视镜检查法的诊断价值。方法：我们与官方补给的GVHD后面的allogeneic识别了8个病人造血的干细胞移植(HSCT)。GVHD组织学地被定义为腺apoptosis的存在，没由另外的煽动性或传染的病原学解释。结果：官方补给的GVHD的症状包括了厌食，恶心，呕吐，水泻，腹的疼痛，官方补给的流血，等等。上面的内视镜的外观从微妙的粘膜浮肿变化了，充血，红斑到明显的侵蚀。Colonoscopic检查显示出弥漫的浮肿，充血，补缀的侵蚀，散布溃疡，腐肉形成并且活跃流血。在官方补给的GVHD的组织学的变化在上皮和薄板propria包括了地窟上皮细胞，地窟的退学学生，和淋巴球的渗入的apoptosis。胃和书籍的右页冒号的参与从diffuse变化了到焦点。结论：内视镜检查法可以在跟随allogeneicHSCT的官方补给的GVHD病人的早诊断起一个重要作用，并且胃肠的活体检视的histologic检查被需要证实最后的诊断。

简介：无线力量传播在这份报纸基于为遥远地植入的微设备的引入的联合被考虑了。收到的卷，集成于微系统和外部播送卷填写一个泛泛地联合的变压器。联合系数在间距错误排列上计算、测量。播送卷的几何尺寸为遥远地交付力量的目标被分析。收到的力量被选择频率的适当价值最大化，调节电容和负担抵抗。一个常规完整的桥整流器电路被采用把交流变换成dc电压。当收到的卷被放在播送coil.This的中心时，收到的dc力量直到有5Vrms的播送电压的160mW可以在很长时间为高力量满足一些微系统的要求。

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简介：Theratfunctionalmaldigestionmodelwasmadebyirregularfeedingforstudyingmechanismsofacupunctureinregulatingrastroidtestinalactivities.ThechangesofthenumberandtheopticaldensityofNo-neuronsingastrointestinalintermuscularnerveswereusedastheindexes.Wistarratswererandomlydividedintoacupuncture,Domperidone,modelandcontrolgroupswithfourratsineachgroup.ThoseratswerefedwithDomperidome1mL/100g/dayatthebeginningofthemodelmakingprocess.Bilateral“Zusanli”(ST36)andright“Weishu”(BL21)werestimulatedfor20minineverysession,onceeverytwodays,continuouslyforonemonth.Onemonthlater,theratswerekilledforsamplingthegastrointestinalwalls.Thesampleswerecutintosectionswhichwerestainedwithimmunohistochemicalmethodforexaminingthenitricoxidesynthase(NOS)reactionwiththereductivecoenzymeⅡ.Theresultsshowedthatacupunctureof“Zusanli”and“Weishu”pointsmightrestoretheNOSactivityofthestomachtothenormallevel.Comparedwiththemodelgroup,Noimmuno-reactionpositiveneurons'numberinacupuncturegroupdecreasedandtheopticaldensityincreased.Theinfluenceofacupunctureontheupperpartofthesmallintestinewasindistinct.ChangesofNOIr-positiveneuronsmaycontributetotheeffectofacupunctureinmodulatinggastrointestinalactivitiesoffunctionalindigestioninclinic.

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简介：AbstractGastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the digestive system and are not sensitive to traditional chemotherapy. Therefore, historically, surgical resection was the only effective therapy. However, the emergence of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of GISTs, because they target c-Kit and PDGF receptor-α (PDGFRA), which are important in GIST development and progression. As research into c-Kit and PDGFRA continues, an increasing number of different TKIs are being used in the clinical setting. This review aims to discuss the current state of chemotherapy for the treatment of GISTs with different genotypes.

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简介：目的：讨胃经穴在胃肠实热型肥胖症治疗中的作用。方法：51例胃肠实热型肥胖症患者随机分为两组，治疗组以胃经取穴为主，对照组采用俞募配穴法取穴。隔日治疗1次，1个月为1个疗程，共治疗3个疗程。观察患者的症状、体征的变化，测量治疗前后的肥胖指标及血瘦素、血脂、血糖、ACHE等实验室指标。结果：与对照组相比，胃经组可显著减少各项肥胖指标（P〈0．01）；改善肥胖患者的高瘦素血症（P〈0．05）和脂代谢紊乱（P〈0．05）；逆转肥胖患者的副交感神经功能亢进的失衡状态（P〈0．05）。结论：经穴位可以作用于肥胖发生和发展的多个环节，是治疗胃肠实热型肥胖症的关键而有效的选穴。