Jianlong Li’s research while affiliated with Lanzhou University and other places

Background Gut microbiome dysbiosis has been implicated in various gastrointestinal and extra-gastrointestinal diseases, but evidence on the efficacy and safety of fecal microbiota transplantation (FMT) for therapeutic indications remains unclear. Methods The gutMDisorder database was used to summarize the associations between gut microbiome dysbiosis and diseases. We performed an umbrella review of published meta-analyses to determine the evidence synthesis on the efficacy and safety of FMT in treating various diseases. Our study was registered in PROSPERO (CRD42022301226). Results Gut microbiome dysbiosis was associated with 117 gastrointestinal and extra-gastrointestinal. Colorectal cancer was associated with 92 dysbiosis. Dysbiosis involving Firmicutes (phylum) was associated with 34 diseases. We identified 62 published meta-analyses of FMT. FMT was found to be effective for 13 diseases, with a 95.56% cure rate (95% CI: 93.88–97.05%) for recurrent Chloridoids difficile infection (rCDI). Evidence was high quality for rCDI and moderate to high quality for ulcerative colitis and Crohn’s disease but low to very low quality for other diseases. Conclusion Gut microbiome dysbiosis may be implicated in numerous diseases. Substantial evidence suggests FMT improves clinical outcomes for certain indications, but evidence quality varies greatly depending on the specific indication, route of administration, frequency of instillation, fecal preparation, and donor type. This variability should inform clinical, policy, and implementation decisions regarding FMT.

Background The occurrence of postoperative complications of distal cholangiocarcinoma (dCCA) is an indicator of poor patient prognosis. This study aimed to determine the immune-nutritional indexes (INIs) that can predict short-term postoperative complications. Methods A retrospective analysis of 148 patients with dCCA who were operated radical pancreaticoduodenectomy at the First Hospital of Lanzhou University from December 2015 to March 2022 was conducted to assess the predictive value of preoperative INIs and preoperative laboratory tests for short-term postoperative complications, and a decision tree model was developed using classification and regression tree (CART) analysis to identify subgroups at risk for overall complications. Results In this study, 83 patients (56.08%) experienced overall complications. Clavien-Dindo grade III-V complications occurred in 20 patients (13.51%), and 2 patients died. The areas under curves (AUCs) of the preoperative prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and neutrophil-to-lymphocyte ratio (NLR) were compared; the PNI provided the maximum discrimination for complications (AUC = 0.685, 95% CI = 0.600–0.770), with an optimal cutoff value of 46.9, and the PNI ≤ 46.9 group had higher incidences of overall complications (70.67% vs. 40.00%, P < 0.001) and infectious complications (28.77% vs. 13.33%, P = 0.035). Multivariate logistic regression analysis identified PNI (OR = 0.87, 95% CI: 0.80–0.94) and total bilirubin (OR = 1.01, 95% CI: 1.00–1.01) were independent risk factors for overall complications ( P < 0.05). According to CART analysis, PNI was the most important parameter, followed by the total bilirubin (TBIL) level. Patients with a PNI lower than the critical value and TBIL higher than the critical value had the highest overall complication rate (90.24%); the risk prediction model had an AUC of 0.714 (95% CI, 0.640–0.789) and could be used to stratify the risk of overall complications and predict grade I-II complications ( P < 0.05). Conclusion The preoperative PNI is a good predictor for short-term complications after the radical resection of dCCA. The decision tree model makes PNI and TBIL easier to use in clinical practice.

Background To assess the predictive value of radiomics for preoperative lymph node metastasis (LMN) in patients with biliary tract cancers (BTCs). Methods PubMed, Embase, Web of Science, Cochrane Library databases, and four Chinese databases [VIP, CNKI, Wanfang, and China Biomedical Literature Database (CBM)] were searched to identify relevant studies published up to February 10, 2022. Two authors independently screened all publications for eligibility. We included studies that used histopathology as a gold standard and radiomics to evaluate the diagnostic efficacy of LNM in BTCs patients. The quality of the literature was evaluated using the Radiomics Quality Score (RQS) and the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The diagnostic odds ratio (DOR), sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive validity of radiomics for lymph node status in patients with BTCs. Spearman correlation coefficients were calculated, and Meta-regression and subgroup analyses were performed to assess the causes of heterogeneity. Results Seven studies were included, with 977 patients. The pooled sensitivity, specificity and AUC were 83% [95% confidence interval (CI): 77%, 88%], 78% (95% CI: 71, 84) and 0.88 (95% CI: 0.85, 0.90), respectively. The substantive heterogeneity was observed among the included studies ( I ² = 80%, 95%CI: 58,100). There was no threshold effect seen. Meta-regression showed that tumor site contributed to the heterogeneity of specificity analysis ( P < 0.05). Imaging methods, number of patients, combined clinical factors, tumor site, model, population, and published year all played a role in the heterogeneity of the sensitivity analysis ( P < 0.05). Subgroup analysis revealed that magnetic resonance imaging (MRI) based radiomics had a higher pooled sensitivity than contrast-computed tomography (CT), whereas the result for pooled specificity was the opposite. Conclusion Our meta-analysis showed that radiomics provided a high level of prognostic value for preoperative LMN in BTCs patients.