The impact of obesity on the prognosis of hepatocellular carcinoma (HCC) has not been well characterized in a Chinese population. Therefore, the aim of this study was to examine the influence of BMI on the clinicopathological characteristics and mortality of patients with HCC. The study cohort consisted of 379 patients who were diagnosed with HCC at the First Affiliated Hospital of Harbin Medical University between June 2012 and August 2014. Study subjects were divided into two body mass index (BMI) categories: normal weight (BMI <23 kg/m2) and overweight (BMI ≥23 kg/m2). Of the 379 patients, 44 (11.6 %) were underweight (<18.5 kg/m2), 172 (45.4 %) had a normal weight (18.5 ≤ BMI < 23.0), 133 (35.1 %) were overweight (23.0 ≤ BMI < 27.5), and 30 (7.9 %) were obese (BMI ≥27.5). After a median follow-up time of 296 (range, 15–720) days, 168 (44.3 %) patients died with median survival time of 159 (range, 15–690) days. Patients with lower BMIs also exhibited a higher liver-related mortality rate (60.6 vs. 22.7 %; p = 1.8 × 10−13) and a shorter survival time (353 days vs. 571 days; p = 6.2 × 10−6) than patients with higher BMIs. In multivariate analysis, the BMI class was also found to be a significant independent impact factor for overall survival (p = 2.2 × 10−8), age, alpha-fetoprotein level, Child–Pugh score, treatment strategy, antiviral treatment, extrahepatic metastasis, and tumor infiltration of the portal vein. Our data suggest that lower BMI has a significant impact regarding poor outcomes in patients with HCC. To better understand the impact of BMI on the prognosis of HCC patients, more large-scale cohort studies will be necessary.

The impact of body mass index (BMI) on the prognosis of patients with colorectal cancer remains largely unknown, particularly in Asian populations. Therefore, the aim of this study was to examine the influence of BMI on clinicopathological characteristics and mortality of Chinese colorectal cancer patients.

INTRODUCTION: Endoscopic retrograde appendicitis therapy (ERAT) is a new and noninvasive endoscopic technique originally developed by Liu in China for the management of acute appendicitis. Although its safety and efficacy have been extensively validated in adult populations, evidence regarding its use in pediatric patients remains scarce. The aim of this study was to evaluate the clinical outcomes of ERAT in pediatric appendicitis. METHODS: This retrospective study analyzed pediatric patients who underwent ERAT in our hospital between January 2019 and August 2022. Data collected included patient demographics, the success rate of ERAT, and the duration of hospital stay. In addition, recurrence rates were assessed during the follow-up to evaluate the safety and long-term efficacy of the procedure. RESULTS: A total of 73 patients were included in this study. Appendiceal intubation was successfully performed in 72 of 73 patients (98.63%). Among these patients, 72.22% of patients had appendiceal fecal stones or food residue, and the success rate of stone removal was 94.23%. Overall, the clinical success rate of the procedure was 91.78%. The median procedure time was 22 minutes (interquartile range 15–36.5), and the median postoperative hospital stay was 2 days (interquartile range 1–4). During the 1-year follow-up, 14.92% of the patients had recurrent appendicitis. DISCUSSION: ERAT seems to be a safe and effective alternative approach to treat appendicitis in pediatric patients, especially for obstructive appendicitis with appendicolith.

Background. A more accurate prediction of liver metastasis (LM) in pancreatic cancer (PC) would help improve clinical therapeutic effects and follow-up strategies for the management of this disease. This study was to assess various prediction models to evaluate the risk of LM based on machine learning algorithms. Methods. We retrospectively reviewed clinicopathological characteristics of PC patients from the Surveillance, Epidemiology, and End Results database from 2010 to 2018. The logistic regression, extreme gradient boosting, support vector, random forest (RF), and deep neural network machine algorithms were used to establish models to predict the risk of LM in PC patients. Specificity, sensitivity, and receiver operating characteristic (ROC) curves were used to determine the discriminatory capacity of the prediction models. Results. A total of 47,919 PC patients were identified; 15,909 (33.2) of which developed LM. After iterative filtering, a total of nine features were included to establish the risk model for LM based on machine learning. The RF showed the most promising results in the prediction of complications among the models (ROC 0.871 for training and 0.832 for test sets). In risk stratification analysis, the LM rate and 5-year cancer-specific survival (CSS) in the high-risk group were worse than those in the intermediate- and low-risk groups. Surgery, radiotherapy, and chemotherapy were found to significantly improve the CSS in the high- and intermediate-risk groups. Conclusion. In this study, the RF model constructed could accurately predict the risk of LM in PC patients, which has the potential to provide clinicians with more personalized clinical decision-making recommendations.

A previously healthy 34-year-old man presented with severe chest pain, with cough and dyspnea lasting for 2 days. The chest pain had begun after a dinner and the consumption of alcohol, but he denied the ingestion of any foreign body. On physical examination, no palpable mass was observed on the neck, and his lungs were clear on auscultation. His laboratory results at presentation showed significant increases of white blood cells (23.02 × 109 /L), with 90 % neutrophils, and C-reactive protein level (180 mg/L). Other tests including serology for cytomegalovirus (CMV) and tuberculosis were within normal limits. A contrast-enhanced computed tomography (CT) scan revealed wall thickening and a low density accumulation in the upper and middle esophagus ([Fig. 1]). Endoscopic examination revealed a longitudinal bulge at 20–30 cm distal to the incisors ([Fig. 2]). The patient was prescribed ciprofloxacin 400 mg intravenously; however, he complained of a fever and chills 2 days later. A three-dimensional reconstruction technique was used to facilitate diagnosis and characterize the esophageal lesion ([Fig. 3]). Notably, repeat endoscopy showed pus flowing from a fistula at the upper part of the bulge, consistent with a diagnosis of esophageal abscess ([Fig. 4a]). With the patient under general anesthesia, an endoscopic incision was performed from the fistula to the end of the bulge using an insulated-tip knife ([Fig. 4b]; [Video 1]). This endoscopic mucosal incision released a large amount of pus and the esophageal wall was intact. Postoperatively, both the patient’s condition and laboratory tests immediately improved. The intramural esophageal abscess was no longer visible on endoscopy or CT examination 3 days postoperatively. On further endoscopic examination, 1 month later, the esophageal longitudinal ulcer from the incision was found to have healed ([Fig. 4c]). Video 1 Treatment of an intramural esophageal abscess by endoscopic mucosal incision. Spontaneous esophageal abscess remains a rare event caused by the longitudinal separation of the esophageal mucosal and submucosal layers [1]. Prompt diagnosis and early therapy are needed to prevent death and prolonged serious illness ([Fig. 5]); the key to the diagnosis is an awareness of its frequent atypical presentations. In clinical settings, mucosal injury due to either iatrogenic etiology or foreign body ingestion can often help to identify an intramural esophageal abscess [2]; however, in a healthy and strong young man with no underlying etiology, the diagnosis may be challenging. Three-dimensional reconstruction provided valuable help with the diagnosis in this case and the endoscopic finding of pus from the fistula was highly suggestive of an esophageal abscess. Finally, endoscopic mucosal incision is the treatment of choice for an intramural esophageal abscess. Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH Article published online: 14 July 2022 © 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany