Jinlin Yang

Background: Remnant gastric cancer (RGC) may develop over markedly different intervals after gastrectomy. We investigated the time-dependent clinicopathological patterns of RGC after Billroth II reconstruction and their implications for endoscopic surveillance. Methods: We retrospectively reviewed patients diagnosed with RGC at West China Hospital between October 2012 and October 2022. Patients were classified by the indication for initial gastrectomy (malignant or benign disease) and the interval to RGC detection (≤3 years, >3 to ≤10 years, and >10 years). Results: Sixty-one patients were included; 39 (63.9%) had tumors at the anastomotic site. Histology was classifiable in 48 patients, of whom 45 had undifferentiated carcinoma (93.8%; 73.8% of the total cohort). The interval to RGC detection was shorter in the carcinoma group than in the benign-disease group (4.8 ± 5.7 vs. 31.6 ± 12.9 years, p < 0.001). Eighteen of 36 patients (50.0%) in the carcinoma group were diagnosed within 3 years, whereas 23 of 25 patients (92.0%) in the benign-disease group were diagnosed after 10 years. All 18 RGCs diagnosed ≤3 years after the initial gastrectomy occurred in patients whose initial indication was gastric carcinoma. In exploratory unadjusted pairwise comparisons among patients with known distant-metastasis status, distant metastasis was more frequent in the ≤3-year group than in the >10-year group (11/17 [64.7%] vs. 6/25 [24.0%], p = 0.012), whereas surgery for RGC was less frequent (5.6% vs. 53.8%, p = 0.001). Conclusions: RGC after Billroth II reconstruction showed distinct temporal patterns. Associations with metastatic burden and surgical treatment were exploratory, and the effects of postoperative interval and initial indication could not be reliably separated. These hypothesis-generating findings require prospective validation before specific surveillance intervals can be recommended.

Objective: To compare the circumferential proportion of mucosal defects, defect length, and the length-to-residual mucosal proportion (LRP) index for predicting esophageal stricture after endoscopic submucosal dissection (ESD) in patients with mucosal defects ≥6 cm, and to explore LRP in defects >10 cm. Methods: This retrospective study included 378 patients undergoing esophageal ESD from February 2014 to June 2020, grouped by stricture status. LRP was defined as defect length divided by residual mucosal proportion, with residual mucosal proportion set at a lower bound of 0.05 for statistical calculation. Receiver operating characteristic analysis compared the three indicators, including subgroup analysis for defects >10 cm. Results: Postoperative stricture occurred in 82 patients (21.7%). Circumferential proportion, defect length, and LRP were higher in the stricture group than in the non-stricture group (all p < 0.001). In the overall cohort, circumferential proportion and LRP showed comparable discrimination (AUC 0.877 vs. 0.876; p = 0.825), both outperforming defect length alone (AUC 0.694; both p < 0.001). In defects >10 cm, LRP showed the highest numerical AUC (0.913), followed by circumferential proportion (0.886) and defect length (0.668). Multivariable analysis confirmed that LRP was independently associated with stricture (per 10-unit increase: OR = 1.225; 95% CI, 1.150–1.304; p < 0.001). Conclusions: LRP was comparable to circumferential proportion and may serve as an exploratory complementary metric in long-segment defects, warranting external validation.

Hypereosinophilic syndromes (HES) are rare disorders characterized by the abnormal accumulation of eosinophils, which can lead to organ damage. The clinica

Psychiatric disorders are associated with several cancers. However, data on the association between different types of psychiatric disorders and colorectal cancer (CRC) are scarce. The aim of this study was to determine whether there is an association between psychiatric disorders and CRC using UK Biobank. We excluded participants with a previous diagnosis of cancer (except non-melanoma skin cancer) prior to baseline and conducted a matched cohort study with new-onset psychiatric disorder patients after recruitment as the exposure group and matched non-psychiatric disorder individuals as the reference group. Through UK Biobank, we obtained clinical diagnoses for the psychiatric-disorder patients from their hospital records. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) of CRC risk after diagnosis of a psychiatric disorder. We identified 29,769 individuals with psychiatric disorders. During follow-up (median duration of 5.69 [IQR: 5.43] years), 190 cases of CRC were identified in the psychiatric patients (1.13 per 1000 person-years), compared with 921 cases in the reference individuals (0.53 per 1000 person-years). Individuals with clinically confirmed psychiatric disorders were associated with an elevated hazard of CRC (HR, 1.93 [95% CI, 1.64–2.27]). The risk of CRC in psychiatric patients is higher in those with multiple psychiatric disorders than single (HR 2.53 [95% CI, 1.90–3.37] vs. 1.78 [95%CI, 1.48–2.13], p < 0.05). Our findings suggest: patients with psychiatric disorders were associated with an elevated hazard of CRC. These findings highlight the need for measures to decrease the risk of CRC in individuals with psychiatric disorders, such as monitoring and early intervention.

Background & Aims: Prophylactic use of antibiotics was found to decrease mortality in patients with cirrhosis and acute variceal bleeding (AVB). Patients with Child A cirrhosis have a low risk of treatment failure and mortality. The present study was designed to investigate the association between antibiotics and Child–Pugh A patients with AVB. Methods: This retrospective analysis was conducted on Child–Pugh class A cirrhotic patients presenting with AVB at West China Hospital between January 2016 and November 2022. The outcome indicators evaluated in this study include the rate of treatment failure within five days, mortality within 6 weeks, incidence of nosocomial infections, and 1‐year cumulative mortality. Results: This study ultimately enrolled 237 patients. The day of patients’ admission was defined as Day 0. A total of 117 patients received prophylactic use of antibiotics on Days 0–1 (Group A), and 120 patients did not receive antibiotics on Days 0–1 (Group B). Baseline characteristics were well‐balanced between the two groups. The 5‐day treatment failure was 8.5% in Group A and 6.7% in Group B ( p = 0.63). The 6‐week mortality was 1.71% in Group A and 0% in Group B ( p = 0.24). The incidence of nosocomial infection (5.98% vs. 6.67%, p = 1.00) and 1‐year cumulative mortality (4.81% vs. 1.89%, p = 0.40) was comparable between the two groups. Conclusions: The antibiotics’ prophylactic use was not associated with 5‐day treatment failure or 6‐week mortality. Prophylactic use of antibiotics may not be routinely necessary in patients with Child A cirrhosis and AVB.

Chronic stress is increasingly recognized as a critical factor influencing tumor progression, but its underlying mechanisms remain incompletely understood. This review examines the role of gut microbiota as a critical mediator linking chronic stress to tumor progression. Recent evidence suggests that chronic stress triggers gut dysbiosis, characterized by reduced microbial diversity, depletion of beneficial bacteria, and enrichment of potentially harmful species. We summarize the mechanisms by which chronic stress regulates gut microbial dysbiosis, including stress-related hormone signaling, intestinal inflammation, mucosal barrier disruption, and altered gut motility. Additionally, we examine how stress-induced dysbiosis contributes to tumor progression through immune suppression, metabolic reprogramming, enhanced tumor stemness, and potentially through barrier dysfunction, and chronic inflammation. We further discuss potential therapeutic interventions, including specific probiotics, prebiotics and other strategies that may help suppress tumor development by modulating the stress-microbiota-cancer axis. In conclusion, these emerging insights provide a foundation for novel therapeutic strategies that target the stress-microbiome-cancer axis, which may help suppress tumor progression and complement conventional cancer treatments to improve clinical outcomes in cancer patients.