Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial

BACKGROUND

A cure for Helicobacter pylori (H. pylori) remains a problem of global concern. The prevalence of antimicrobial resistance is widely rising and becoming a challenging issue worldwide. Optimizing sequential therapy seems to be one of the most attractive strategies in terms of efficacy, tolerability and cost. The most common sequential therapy consists of a dual therapy [proton-pump inhibitors (PPIs) and amoxicillin] for the first period (5 to 7 d), followed by a triple therapy for the second period (PPI, clarithromycin and metronidazole). PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics, hence the idea of using new generation molecules.

AIM

To compare an optimized sequential therapy with the standard non-bismuth quadruple therapies of 10 and 14 d, in terms of efficacy, incidence of adverse effects (AEs) and cost.

METHODS

This open-label prospective study randomized 328 patients with confirmed H. pylori infection into three groups (1:1:1): The first group received quadruple therapy consisting of twice-daily (bid) omeprazole 20 mg, amoxicillin 1 g, clarithromycin 500 mg and metronidazole 500 mg for 10 d (QT-10), the second group received a 14 d quadruple therapy following the same regimen (QT-14), and the third group received an optimized sequential therapy consisting of bid rabeprazole 20 mg plus amoxicillin 1 g for 7 d, followed by bid rabeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg for the next 7 d (OST-14). AEs were recorded throughout the study, and the H. pylori eradication rate was determined 4 to 6 wk after the end of treatment, using the 13C urea breath test.

RESULTS

In the intention-to-treat and per-protocol analysis, the eradication rate was higher in the OST-14 group compared to the QT-10 group: (93.5%, 85.5% P = 0.04) and (96.2%, 89.5% P = 0.03) respectively. However, there was no statistically significant difference in eradication rates between the OST-14 and QT-14 groups: (93.5%, 91.8% P = 0.34) and (96.2%, 94.4% P = 0.35), respectively. The overall incidence of AEs was significantly lower in the OST-14 group (P = 0.01). Furthermore, OST-14 was the most cost-effective among the three groups.

CONCLUSION

The optimized 14-d sequential therapy is a safe and effective alternative. Its eradication rate is comparable to that of the 14-d concomitant therapy while causing fewer AEs and allowing a gain in terms of cost.

Nesfatin-1 inhibits gastric acid secretion by cultured rat gastric mucosa cells

AIM: To clarify the effect of nesfatin-1 on gastric acid secretion and the expression of the H+/K+-ATPase mRNA and protein in rat gastric mucosa cells in vitro.

METHODS: Gastric mucosa cells were isolated from SD rats by enzymolysis and identified by immunofluorescence staining. Cultured rat gastric mucosa cells were divided into control group and nesfatin-1 group, and the nesfatin-1 group was pretreated with different concentrations (0, 10^-4, 10^-3, 10^-2, 10^-1 μmol/L) of nesfatin-1 for different durations (0, 1, 2, 3, 4 h). The effect of nesfatin-1 on gastric acid secretion was investigated by monitoring ¹⁴C-aminopyrine (¹⁴C-AP) accumulation, and the expression of H⁺/K⁺-ATPase α and β subunit mRNA and protein was examined by real-time PCR and Western blot.

RESULTS: Pretreatment with nesfatin-1 at a dose of 10^-1 or 10^-2 μmol/L for 2 or 3 h inhibited gastric acid secretion, but nesfatin-1 at a dose of 10^-3 or 10^-4 μmol/L had no such effect. Nesfatin-1 at a dose of 10^-1 μmol/L inhibited the expression of H⁺/K⁺-ATPase α subunit mRNA after pretreatment for 1, 2, or 3 h and inhibited the expression of H⁺/K⁺-ATPase β subunit mRNAs after pretreatment for 1 or 2 h. In the dose range between 10^-4 to 10^-1 μmol/L, nesfatin-1 dose-dependently inhibited the expression of H⁺/K⁺-ATPase α subunit and β subunit mRNA after pretreatment for 2 h. Nesfatin-1 at a dose of 10^-1 μmmol/L inhibited H⁺/K⁺-ATPase α subunit protein expression after pretreatment for 1, 2 or 3 h and inhibited H⁺/K⁺-ATPase β subunit protein expression after pretreatment for 2 or 3 h. In the dose range between 10^-3 to 10^-1 μmol/L, nesfatin-1 dose-dependently inhibited H⁺/K⁺-ATPase α and β subunit protein expression after pretreatment for 2 h.

CONCLUSION: Our data suggest that nesfatin-1 inhibits gastric acid secretion by rat gastric mucosa cells in vitro possibly by down-regulating the expression of H⁺/K⁺-ATPase mRNA and protein..

Exogenous lipoid pneumonia associated with nasal decongestants use: A narrative review of an under recognized clinical entity

Exogenous lipoid pneumonia is a rare and under recognized pulmonary disorder caused by the inhalation or aspiration of fat-like substances. Nasal decongestants containing mineral oils or paraffin are emerging as overlooked etiological agents. This review consolidates existing literature to delineate the clinical, radiological, and pathological features of exogenous lipoid pneumonia induced by nasal decongestants, highlight diagnostic challenges, and underscore the importance of thorough patient history in early diagnosis and management. This condition, while preventable, can result in serious pulmonary complications if not recognized early. It necessitates a multidisciplinary approach that incorporates careful history taking, high-resolution imaging, cytological assessment, and public health vigilance.

Strategic insights into the cultivation of pancreatic cancer organoids from endoscopic ultrasonography-guided biopsy tissue

BACKGROUND

The frequent suboptimal efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) to culture pancreatic cancer (PC) organoids (PCOs) poses a major challenge in the advancement of personalized medicine for advanced PC.

AIM

To explore how to obtain appropriate puncture tissues from EUS-FNB and optimize the strategy for efficiently constructing PCOs, providing an efficient tool for the advancement of personalized medicine.

METHODS

Patients who underwent EUS-FNB for the diagnosis of PC tissue were prospectively enrolled. We refined the endoscopic biopsy procedures and organoid cultivation techniques. All tissue specimens verified by on-site pathological assessment were cultured in a semi-suspended medium in a microfluidic environment. We assessed differences in PCOs cultured beyond and below five generations examining patient demographics, specimen and organoid attributes, and the sensitivity of organoids to a panel of clinical drugs through cell viability assays.

RESULTS

In this study, 16 patients with PC were recruited, one sample was excluded because onsite cytopathology showed no tumor cells. Successful organoid generation occurred in 93.3% (14 of 15) of the EUS-FNB specimens, with 60% (9 of 15) sustaining over five generations. Among these patients, those with a history of diabetes, familial cancer, or larger tumors exhibited enhanced PCO expandability. The key factors influencing long-term PCOs expansion included initial needle sample quality (P = 0.005), rapid initiation of organoid culture post-isolation (P ≤ 0.001), and high organoid activity (P = 0.031). Drug sensitivity analysis revealed a partial response in two patients following therapeutic intervention and surgery and stable disease in four patients, indicating a moderate correlation between organoid response and clinical outcomes.

CONCLUSION

Optimal initial needle sampling, rapid and precise biopsy sample processing, process isolated samples as soon as possible, and sufficient cellular material are crucial for successful cultivating PCOs. High organoid activity is an important factor in maintaining their long-term expansion, which is essential for shortening the time of drug sensitivity analysis and is the basis of PC research.

Closed loop ileus caused by a defect in the broad ligament: A case report

BACKGROUND

Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity. Only a few cases have been reported in the literature.

CASE SUMMARY

We present the case of a 44-year-old, healthy patient with no prior history of abdominal surgery who developed a closed loop ileus due to an internal hernia secondary to a defect in the right broad ligament. She first presented to the emergency department with diarrhea and vomiting. As she had had no previous abdominal surgery, she was diagnosed with probable gastroenteritis and discharged. The patient subsequently returned to the emergency department due to a lack of improvement in her symptoms. Blood tests showed an elevated white blood cell count and a closed loop ileus was diagnosed on an abdominal computer tomography scan. Diagnostic laparoscopy revealed an internal hernia entrapped in a 2 cm large defect in the right broad ligament. The hernia was reduced and the ligament defect was closed using a running, barbed suture.

CONCLUSION

Bowel incarceration through an internal hernia may present with misleading symptoms and laparoscopy may reveal unexpected findings.

Validation of “Victorian institute of sports assessment for patellar tendons” in patellofemoral pain: Reliability, interpretability and feasibility study

BACKGROUND

The Victorian institute of sports assessment for patellar tendons questionnaire (VISA-P), a valid tool for patellar tendinopathy, has been used for patellofemoral pain (PFP).

AIM

To validate VISA-P in PFP.

METHODS

Study of validity, responsiveness and feasibility following COSMIN. Inclusion criteria: Subjects with PFP, aged 18 to 55. Agreement among 10 experts on the relevance and clarity of each item using Aiken's V coefficient determined content validity. An exploratory factorial analysis established structural validity. The correlation of VISA-P with knee injury and osteoarthritis outcome score for PFP and Osteoarthritis (KOOS-PF) and Kujala patellofemoral score (KPS; specific for PFP) analyzed the construct validity. Internal consistency was calculated with Cronbach's α and test-retest reliability with the intraclass correlation coefficient (ICC). Feasibility considered the subjects' self-completion time.

RESULTS

The sample consisted of 103 knees from 73 subjects (47 female/26 male; aged 34.9 ± 13 SD). The items were relevant and clear, with the exception of item-8, which didn't reach an acceptable level of agreement on clarity. Exploratory factorial analysis found a 2-factor solution, which explained 63.48% of the variance. VISA-P achieved a strong and significant correlation with KOOS-PF (Spearman rho = 0.826; P < 0.001) and KPS (Spearman rho = 0.771; P < 0.001). The questionnaire showed adequate reliability (Cronbach's α: 0.752; ICC: 0.934; P < 0.0001; 95%CI: 0.902-0.955). The mean self-completion time was 232 ± 0.52 SD seconds.

CONCLUSION

VISA-P proved to be valid and reliable to functionally assess PFP and/or chondromalacia patella. VISA-P is a feasible tool in the clinical and research environment, quick and easy to complete.

Helicobacter pylori infection promotes the progression of gastric cancer by regulating the expression of DMBT1

BACKGROUND

Each year, more than a million people are diagnosed with gastric cancer (GC) worldwide, and the incidence of this disease is projected to increase. Helicobacter pylori (H. pylori) is the major cause of GC. Managing infections caused by H. pylori and investigating their contribution to GC carcinogenesis are crucial for advancing diagnosis and treatment. Deleted in malignant brain tumors 1 (DMBT1) is associated with the development of H. pylori and GC. However, the precise underlying mechanism is unclear.

AIM

To explore the role of DMBT1, as modulated by H. pylori, in the development, proliferation, and metastasis of GC.

METHODS

Utilizing human GC cells, DMBT1 gene silencing, and H. pylori treatment, four cell groups (control, H. pylori, si-DMBT1, and H. pylori + si-DMBT1) were subjected to cell counting kit-8, scratch, and Transwell assays. The DMBT1 expression was assessed by quantitative real-time polymerase chain reaction and Western blot.

RESULTS

In cellular tests, H. pylori + si-DMBT1 showed the greatest ability to proliferate, migration, and invasion capabilities, followed by the si-DMBT1, H. pylori, and control groups. DMBT1 mRNA was found to be the highest in control group, next in si-DMBT1, H. pylori and H. pylori + si-DMBT1, while H. pylori + si-DMBT1 showed the least expression. The results the Western blot assay showed a consistent trend of decreasing DMBT1 protein and mRNA levels.

CONCLUSION

Through inhibition of DMBT1, H. pylori could enhance GC’s proliferation, metastasis and invasion. Our findings revealed a novel connection between H. pylori infection, inflammation, and GC.

Betel quid chewing and oral potential malignant disorders and the impact of smoking and drinking: A meta-analysis

BACKGROUND

Oral potential malignant disorders (OPMDs) are a precancerous condition of oral disease. Several studies have found that betel quid chewing, smoking and alcohol drinking might be the risk factors of OPMDs. But the relationships of them, especially their interaction are still inconclusive.

AIM

To evaluate the relationship between betel quid chewing and OPMDs and to explore the interaction of smoking and alcohol drinking on the relationship.

METHODS

We searched PubMed, Web of Science, Embase and the Cochrane Library databases with items complete until January 2021 for relevant studies. The research data were extracted according to the inclusion criteria. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the effect size. Subgroup analysis was performed to assess interactions between exposures and OPMDs. Relative excess risk of interaction (RERI) was used to estimate the size of interaction.

RESULTS

Nine articles were selected in the final meta-analysis. The results showed that betel quid chewing (pooled OR: 8.70, 95%CI: 5.18-14.61), alcohol consumption (pooled OR: 1.95, 95%CI: 1.5-2.55), and smoking (pooled OR:4.35, 95%CI: 3.06-6.2) could significantly increase the risk of OPMDs compared to individuals without these behaviors. Smoking and alcohol drinking synergistically increased the association between betel quid chewing and OPMDs (pooled OR_(BQ+SM):14.38, 95%CI: 7.14-28.95; pooled OR_(BQ+DK): 11.12, 95%CI: 8.00-15.45, respectively). The RERI_(BQ+SM) and RERI_(BQ+DK) were 2.33 and 1.47, respectively.

CONCLUSION

The synergistic effects between smoking/drinking and betel quid highlights the importance of focusing on individuals with multiple exposures. Further study should be conducted to confirm these interactions.

NOTCH1 combined with chemotherapy synergistically inhibits triple-negative breast cancer

BACKGROUND

Chemotherapy for triple-negative breast cancer (TNBC) is often limited in efficacy due to drug resistance. The NOTCH1 pathway significantly contributes to the advancement of tumors, but its mechanism of action in sensitizing TNBC to chemotherapy and its association with the downstream molecule, NT5E, is unclear.

AIM

To explore the molecular mechanisms by which NOTCH1 regulates cisplatin sensitivity in TNBC cells, and to validate its synergistic effect with NT5E.

METHODS

Expression of NOTCH1 in MDA-MB-231 cells was silenced using RNA interference, and the changes in cell proliferation, migration and cisplatin sensitivity were measured in combination with cell function experiments. The regulatory relationship between NOTCH1 and NT5E was analyzed using qPCR and Western blotting, and the silencing effect of NOTCH1 was verified using NT5E overexpression experiments.

RESULTS

Knockdown of NOTCH1 hindered the growth and motility of TNBC cells and lowered cisplatin’s half-maximal inhibitory concentration. Expression of NOTCH1 and NT5E was positively correlated, and NOTCH1 silencing led to a decrease in the expression of NT5E. Elevated NT5E expression attenuated the suppressive effects of NOTCH1 knockdown on both cell proliferation and cisplatin response.

CONCLUSION

NOTCH1 enhances TNBC cisplatin chemosensitivity by regulating NT5E expression. This study provides a new target and experimental basis for the development of combination therapy strategies for TNBC.

Strategies for the comprehensive treatment of gastric cancer ovarian metastasis

The incidence of gastric cancer is currently increasing, with gastrectomy and D2 Lymphadenectomy being the primary treatments for resectable gastric cancer. For advanced or unresectable metastatic gastric cancer, systemic treatment options include chemotherapy, targeted therapy, or immunotherapy. Krukenberg tumours are types of metastatic tumours in the ovaries that exclusively occur in female patients and that originate from the stomach. Previously deemed an incurable stage of advanced disease, the prognosis of patients with ovarian metastases from gastric cancer depends on multiple factors, including tumour biology and treatment response. With the development of comprehensive cancer treatment options, the combination of surgery and chemotherapy has gradually become the primary treatment for patients with ovarian metastasis from gastric cancer. Individualised comprehensive treatment regimens are crucial for improving patient outcomes. This review summarises the comprehensive treatment strategies for ovarian metastasis from gastric cancer.

Epithelioid angiosarcoma of the cervical spine: A case report

BACKGROUND

Epithelioid angiosarcoma (EA) is an aggressive, malignant endothelial-cell tumor of vascular or lymphatic origin. EA often arises from deep soft tissues such as pleura, breast, bone and gastrointestinal tract. It usually affects patients aged 60-70 years and is associated with high recurrence and metastasis rates with surgical resection as the primary treatment of choice. Overall survivals are generally poor, ranging from 6 to 16 months. More than 50% of patients died of disease within 2 to 3 years of diagnosis.

CASE SUMMARY

We present a rare case of EA of the cervical spine causing a C6 pathological fracture complicated by severe kyphosis. The patient received C4-7 posterior laminectomy and C2/3/4/7/T1 transpedicular screw fixation, followed by anterior C5-6 corpectomy with allograft bone fusion and cervical plate fixation. Postoperative radiotherapy was administered without delay. However, the patient died of rapidly progressive acute respiratory distress syndrome 3 weeks after the second surgery.

CONCLUSION

EA with spinal involvement is extremely rare. Early detection and cord decompression may prevent neurological deterioration and preserve better quality of life.

Transformed gastric mucosa-associated lymphoid tissue lymphoma originating in the colon and developing metachronously after Helicobacter pylori eradication: A case report

BACKGROUND

Helicobacter pylori (H. pylori) eradication treatment for primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma has already been established. However, t (11;18) (q21;q21)/API2-MALT1 translocation-positive lesions are a type of primary gastric MALT lymphoma in which a response to eradication treatment is difficult to achieve. In addition, trisomy 18 may be associated with diffuse large B-cell lymphoma (DLBCL) transformation of gastric MALT lymphoma.

CASE SUMMARY

A 66-year-old man was diagnosed with MALT lymphoma in the ascending colon by colonoscopy and biopsy. Two years later, esophagogastroduodenoscopy revealed chronic atrophic gastritis that was positive for H. pylori, and eradication treatment was administered. Two years and nine months later (at the age of 70), a new ulcerative lesion suggestive of MALT lymphoma appeared in the gastric body, and six months later, a similar lesion was also found in the fundus. One year later (4 years and 3 months after H. pylori eradication), at the age of 72, the lesion in the gastric body had become deeper and had propagated. A biopsy revealed a pathological diagnosis of DLBCL. Both MALT lymphoma lesions in the ascending colon and DLBCL lesions in the stomach were positive for the t (11;18) (q21;q21)/API2-MALT1 translocation, and trisomy 18q21 was also detected. After 6 courses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy, all of the above lesions disappeared [complete remission (CR)], and CR has been maintained for more than 3 years. In addition, both the colonic and gastric lesions were proven to have the same clonality.

CONCLUSION

Because the patient had a MALT1 translocation with trisomy 18q21, it was thought that this gastric MALT lymphoma developed independently of H. pylori infection and progressed.

Comparison of different severity scores in correlating hemoglobin levels with the severity of hepatic decompensation: An observational study

BACKGROUND

Chronic liver disease is a growing global health problem, leading to hepatic decompensation characterized by an array of clinical and biochemical complications. Several scoring systems have been introduced in assessing the severity of hepatic decompensation with the most frequent ones are Child-Pugh score, model of end-stage liver disease (MELD) score, and MELD-Na score. Anemia is frequently observed in cirrhotic patients and is linked to worsened clinical outcomes. Although studies have explored anemia in liver disease, few have investigated the correlation of hemoglobin level with the severity of hepatic decompensation.

AIM

To determine the relationship between hemoglobin levels and the severity of decompensated liver disease and comparing the strength of this correlation using the Child-Pugh, MELD, and MELD-Na scores.

METHODS

This cross-sectional study was conducted at a tertiary care hospital with 652 decompensated liver disease patients enrolled in the study. Data was collected on demographics, clinical history, and laboratory findings, including hemoglobin levels, bilirubin, albumin, prothrombin time (international normalized ratio), sodium, and creatinine. The Child-Pugh, MELD, and MELD-Na scores were calculated. Statistical analysis was performed using Statistical Package for the Social Sciences version 26, and correlations between hemoglobin levels and severity scores were assessed using Spearman's correlation coefficient.

RESULTS

The study included 405 males (62.1%) and 247 females (37.9%) with an average age of 58.8 years. Significant inverse correlations were found between hemoglobin levels and Child-Pugh, MELD, and MELD-Na scores (P < 0.01), with the MELD scoring system being the strongest correlator among all. One-way analysis of variance revealed significant differences in hemoglobin levels across the severity groups of each scoring system (P = 0.001). Tukey's post hoc analysis confirmed significant internal differences among each severity group.

CONCLUSION

Understanding the correlation between hemoglobin and liver disease severity can improve patient management by offering insights into prognosis and guiding treatment decisions.

Sequence of events leading to primary biliary cholangitis

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease that is observed more frequently in middle-aged women. This disorder is considered an autoimmune disease, since liver injury is sustained by the presence of self-directed antimitochondrial antibodies targeting the bile duct cells. The prognosis may vary depending on an early diagnosis and response to therapy. However, nearly a third of patients can progress to liver cirrhosis, thus requiring a liver transplant. Traditional immunosuppressive therapies, commonly employed for other autoimmune diseases, have limited effects on PBC. In fact, dramatic functional changes that occur in the biliary epithelium in the course of inflammation play a major role in perpetuating the injury. In this minireview, after a background on the disease and possible predisposing factors, the sequential cooperation of cellular/molecular events leading to end-stage PBC is discussed in detail. The rise and maintenance of the autoimmune process, as well as the response of the biliary epithelia during inflammatory injury, are key factors in the progression of the disease. The so-called "ductular reaction (DR)", intended as a reactive expansion of cells with biliary phenotype, is a process frequently observed in PBC and partially understood. However, recent findings suggest a strict relationship between this pathological picture and the progression to liver fibrosis, cell senescence, and loss of biliary ducts. All these issues (onset of chronic inflammation, changes in secretive and proliferative biliary functions, DR, and its relationship with other pathological events) are discussed in this manuscript in an attempt to provide a snapshot, for clinicians and researchers, of the most relevant and sequential contributors to the progression of this human cholestatic disease. We believe that interpreting this disorder as a multistep process may help identify possible therapeutic targets to prevent evolution to severe disease.

Therapeutic potential of elafibranor in alcohol-associated liver disease: Insights into macrophage modulation and fibrosis reduction

Alcohol-associated liver disease (ALD) is a major global health concern, contributing to liver injury, morbidity, and mortality. Elafibranor (EFN), a dual peroxisome proliferator-activated receptor α/δ agonist, has shown promise as a therapeutic candidate in preclinical studies. EFN reduces liver fibrosis by inhibiting lipid accumulation, apoptosis, and inflammatory pathways (LPS/TLR4/NF-κB), while enhancing autophagy and antioxidant responses. It also improves intestinal barrier function and modulates gut microbiota, reducing endotoxin-producing bacteria and increasing beneficial species. By strengthening the intestinal barrier and suppressing pro-inflammatory mediators like tumor necrosis factor-alpha and interleukin-6, EFN mitigates hepatic stellate cell activation and fibrogenic signaling. Macrophages play a central role in ALD progression, and EFN's ability to modulate macrophage activity further highlights its anti-inflammatory properties. This review emphasizes EFN's dual-targeted approach, addressing both hepatic and intestinal dysfunctions, distinguishing it from conventional ALD treatments. While preclinical results are promising, EFN remains under clinical investigation, with ongoing trials evaluating its safety and efficacy. Future research should focus on elucidating EFN's molecular mechanisms and advancing its clinical application to establish its therapeutic potential in human populations. EFN represents a novel, comprehensive strategy for ALD management, targeting both liver and gut pathologies.

Impacts of SARS-CoV-2 on diabetes mellitus: A pre and post pandemic evaluation

The coronavirus disease 2019 (COVID-19) pandemic caused by the novel beta coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) crippled the whole world and has resulted in large number of morbidity and mortality. The origin of the SARS-CoV-2 is still disputed. The risk of infection with SARS-CoV-2 is dependent on several risk factors as observed in many studies. The severity of the disease depends on many factors including the viral strain, host immunogenetics, environmental factors, host genetics, host nutritional status and presence of comorbidities like hypertension, diabetes, Chronic Obstructive Pulmonary Disease, cardiovascular disease, renal impairment. Diabetes is a metabolic disorder mainly characterized by hyperglycemia. Diabetic individuals are intrinsically prone to infections. SARS-CoV-2 infection in patients with diabetes result in β-cell damage and cytokine storm. Damage to the cells impairs the equilibrium of glucose, leading to hyperglycemia. The ensuing cytokine storm causes insulin resistance, especially in the muscles and liver, which also causes a hyperglycemic state. All of these increase the severity of COVID-19. Genetics also play pivotal role in disease pathogenesis. This review article focuses from the probable sources of coronaviruses and SARS-CoV-2 to its impacts on individuals with diabetes and host genetics in pre- and post-pandemic era.

Mood alteration and heart rate variability in patients with cancer on treatment

In this article, Deng and Song showed compelling evidence on the connection between heart rate variability (HRV) alterations and cancer in 127 cancer patients compared with healthy reference individuals, highlighting autonomic nervous system dysfunction as a significant physiological manifestation in cancer patients. We discussed that the reduced HRV may be associated with cancer treatments, e.g., operation, chemotherapy and pain control and psychological response such as depression and anxiety related to the affected cancer. A management such as medicine to mood disturbances related to cancer has been shown a benefit to improve HRV in cancer patients.

Rising trend of E-cigarettes among adolescents of Pakistan and cardiovascular implications of electronic nicotine delivery systems

It is a common misconception that e-cigarettes are safer than tobacco smoking, given their adverse cardiopulmonary effects, habituation, and the fact that it is only a fashion based manifestation to sell and use them. Therefore, the use of e cigarettes should not be encouraged as an alternative and pragmatic measure should be taken to profess this agenda.

RAF1 mutation expands the cardiac phenotypic spectrum of Noonan syndrome: A case report

BACKGROUND

Noonan syndrome is a relatively common autosomal dominant genetic disorder characterized by cardiovascular defects owing to functional abnormalities in key genes such as RAF1. Mutations in RAF1 are typically associated with hypertrophic cardiomyopathy (HCM). However, in this case, the patient exhibited atrial and ventricular septal defects (VSDs).

CASE SUMMARY

This case report describes an 11-year-old boy diagnosed with Noonan syndrome, in whom genetic testing revealed a c.770C>T (p.Ser257 Leu) mutation in RAF1. The patient presented with intermittent chest discomfort and shortness of breath, symptoms that significantly worsened after physical activity. Clinical evaluation revealed marked growth retardation and multiple physical abnormalities. Electrocardiographic and echocardiographic assessments revealed VSDs, atrial septal defects, and left ventricular outflow tract obstruction. Following multidisciplinary consultation, the patient underwent cardiac surgical intervention, which led to clinical improvement; however, they subsequently developed a third-degree atrioventricular block, necessitating the implantation of a permanent pacemaker. During follow-up, echocardiographic findings demonstrated near-complete resolution of the shunt across the atrial and ventricular septa, significant improvement in left ventricular outflow tract obstruction, and notable reduction in ventricular septal thickness. A genetic mutation at the c.770C>T (p.Ser257 Leu) locus of RAF1 is typically associated with HCM and pulmonary hypertension. However, this patient’s clinical phenotype manifested as HCM, atrial septal defect, and VSD, suggesting that this mutation may involve a different pathophysiological mechanism.

CONCLUSION

This case confirms the genotype-phenotype heterogeneity of Noonan syndrome and highlights the complex management requirements of RAF1 mutation-associated cardiac pathologies. Early surgical intervention can ameliorate structural defects, but it must be integrated with genetic counseling and lifelong monitoring to optimize patient outcomes.

Diagnostic characteristics and hepatic histopathology in 115 patients with liver injury of unknown reasons

AIM: To improve the awareness of liver injury of unknown causes by analyzing the diagnostic and pathological features of unexplained liver injury.

METHODS: A total of 115 patients with liver injury of unknown reasons were enrolled in this study. The biochemical and immunological features, as well as virus markers, abdominal imaging findings and hepatic histopathology were analyzed.

RESULTS: A definite diagnosis was achieved by liver biopsy in 109 patients. Among them, 38 were diagnosed with primary biliary cirrhosis (PBC), and the main pathological feature was non-suppurative inflammation in the bile duct; 31 with autoimmune hepatitis (AIH), which showed obvious interface inflammation in liver tissue; 27 with nonalcoholic fatty liver disease (NAFLD), which showed visible hepatic steatosis and ballooning degeneration; 4 with occult hepatitis B, which presented with portal inflammation and infiltration of lymphocytes and were positive for HBcAg and/or HBsAg as revealed by immunohistochemistry; 2 with hepatic amyloidosis, which showed a lot of eosin amyloid deposits reactive with Congo red in liver cells and blood sinus; 2 with hemochromatosis, which showed obvious iron pigment deposition in liver cells; 2 with glycogen storage disease, which showed extensive hyaline degeneration in hepatic cells and was positive for Dpas; 1 with schistosomiasis with schistosome eggs detected microscopically; 1 with toxoplasmosis, and electron microscopy revealed Toxoplasma gondii rhoptry; 1 with Dubin-Johnson syndrome, which showed thick, dark brown pigment particles in liver cells. There were still 6 cases in whom a definite diagnosis could not be achieved after liver biopsy.

CONCLUSION: Autoimmune liver diseases are main causes of liver injury of unknown causes, followed by NAFLD. Liver parasite, genetic diseases and metabolic diseases are rare. Liver biopsy should be emphasized in patients with liver injury of unknown reasons.

Role of regulatory T cells in pathogenesis and therapy of autoimmune liver disease

Autoimmune liver disease (AILD) is a group of autoimmune-mediated hepatobiliary injuries, including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. It has been demonstrated that gene susceptibility, molecular mimicry, and abnormal immune regulation networks contribute to the occurrence and progression of AILD, while the mechanism of the related abnormal immune environment remains undetermined. It is currently believed that autoimmune diseases are mainly caused by the destruction of autoimmune tolerance mechanisms. Regulatory T cell (Treg), as a key factor to peripheral immune tolerance, may play a critical role in AILD. This article aims to elucidate the pathogenesis of AILD from the perspective of Treg cells and provide insight into the application of Treg cells in the therapy of AILD.

Post-endoscopic procedure satisfaction scores: Can we improve?

AIM

To organize post-procedure satisfaction data into a useful reference and analyze patient-centered parameters to find trends that influence patient satisfaction.

METHODS

A robust database of two cohorts of outpatients that underwent an endoscopic procedure at Georgetown University Hospital at two separate three-month intervals ranging from November 2012 to January 2013 and November 2015 to January 2016 was compiled. Time of year was identical to control for weather/seasonal issues that may have contributed to the patient experience. The variables recorded included age, sex, body mass index (BMI), type of procedure, indication for procedure, time of the procedure, length of the procedure, type of prep used, endoscopist, satisfactory score, and comments/reasons for score. For continuous variables, differences in averages were tested by two sample t-test, Wilcoxon rank sum test, and ANOVA as appropriate. For categorical variables, differences in proportions between two groups were tested by χ2 test. Correlation test and linear regression analyses were conducted to examine relationships between length of procedure and continuous predictors. A P value < 0.05 used to indicate statistically significant relationship.

RESULTS

The primary outcome of this study was to assess if telephone outreach after an endoscopic intervention was a satisfactory method of obtaining post-procedure satisfaction scores from patients at a tertiary care center. With the addition of post-procedure calls, instilled in January 2014, the response rate was 40.5% (508/1256 patients) from a prior completion rate of 3.4% (31/918) with the mail out survey initially. There was a statistically significant improved response rate pre and post intervention with P < 0001. The secondary outcome of this study was to assess if we could use predictive analytics to identify independent predictors of procedure length, such as gender, age, type of procedure, time of procedure, or BMI. The combined pre and post intervention data was used in order to optimize the power to identify independent predictors of procedure length. The total number of patient's data analyzed was 2174. There was no statistically significant difference in procedure length between males and females with P value 0.5282. However, there was a small (1 min), but statistically significant difference (P = 0.0185) in procedure length based on the time of day the procedure took place, with afternoon procedures having a longer duration than morning procedures. The type of procedure was an independent predictor of procedure length as demonstrated with P value < 0.0001. There is a statistically significant correlation between age and procedure length, although it is only a weak relationship with a correlation coefficient < 0.3. Contrary to patient age, BMI did not have a statistically significant correlation with procedure length (P = 0.9993), which was also confirmed by linear regression analysis.

CONCLUSION

Our study proves calling patients after endoscopy improves post-procedure satisfaction response rates and changing procedural time allotment based on patient characteristics would not change endoscopic workflow.

Expression of Bag-1 and Bcl-2 and its significance in gastric cancer

AIM: To investigate the expression of Bag-1 and Bcl-2 protein and its clinical significance in gastric cancer (GC).

METHODS: Immunohistochemistry was used to detect the expressison of Bag-1 and Bcl-2 protein in 92 patients with gastric cancer and 40 normal tissues as control.

RESULTS: Compared with normal mucosa, Bag-1 and Bcl-2 were over-expressed in gastric cancerous tissues (60.9% vs 7.5%, 72.8% vs 10%, P<0.01). The expression of Bcl-2 protein was significantly correlated with the differentiation degree (r_s = 0.513, P<0.05) and the expression of Bag-1 was significantly associated with Bcl-2 level in gastric cancer (r_s = 0.522, P<0.01).

CONCLUSION: The over-expression of Bcl-2 leads to uncontrolled growth and unceasingly increases of GC cells by accelerating cell transformation and proliferation. Bag-1 promotes the function of Bcl-2 and co-expression of Bag-1 and Bcl-2 may mean poor prognosis of GC patients.

Gastroparesis, a diabetic complication causing further, even serious, complications: How to prevent its worsening?

Gastroparesis is a severe diabetic complication, caused by a progressive multifactorial enteric neuropathy. To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progression towards full-blown disease source of further complications and requesting effective, but unsafe, drugs as well as invasive surgical treatments. This aim can be achieved by detecting its first signal represented by the gastric emptying (GE) delay, by using, among the tests to measure GE, the simple, safe, reliable, and easily available one, that is real-time ultrasonography, possibly done annually. Once the GE delay has been identified, it is necessary to evaluate with endoluminal functional lumen imaging probe or manometry whether it depends on pylorospasm, which should be treated by means of non-surgical endoscopic therapies. If, instead, it depends on initial gastropathy, detected by electrogastrograhic body surface gastric mapping, it should be treated with the safest prokinetic drugs and with the newly emerging treatments, thus distancing heavy medical and surgical treatments, while waiting for future solutions.

Diagnostic accuracy and quality of artificial intelligence models in irritable bowel syndrome: A systematic review

BACKGROUND

Irritable bowel syndrome (IBS) affects approximately 9%-12% of the global population, presenting substantial diagnostic challenges due to symptom subjectivity and lack of definitive biomarkers.

AIM

To systematically examine the diagnostic accuracy of artificial intelligence (AI) models applied to various biomarkers in IBS diagnosis.

METHODS

A comprehensive search of six databases identified 18053 articles published up to May 31, 2024. Following screening and eligibility criteria, six observational studies involving 1366 participants from the United Kingdom, China, and Japan were included. Risk of bias and reporting quality were assessed using quality assessment of diagnostic accuracy studies-2, prediction model risk of bias assessment tool-AI, and transparent reporting of a multivariable prediction model for individual prognosis or diagnosis-AI tools. Key metrics included sensitivity, specificity, accuracy, and area under the curve (AUC).

RESULTS

The included studies applied AI models such as random forests, support vector machines, and neural networks to biomarkers like fecal microbiome composition, gas chromatography data, neuroimaging features, and protease activity. Diagnostic accuracy ranged from 54% to 98% (AUC: 0.61-0.99). Models using fecal microbiome data achieved the highest performance, with one study reporting 98% sensitivity and specificity (AUC = 0.99). While most studies demonstrated high methodological quality, significant variability in datasets, biomarkers, and validation methods limited meta-analysis feasibility and generalizability.

CONCLUSION

AI models show potential to improve IBS diagnostic accuracy by integrating complex biomarkers which will aid the development of algorithms to direct treatment strategies. However, methodological inconsistencies and limited population diversity underscore the need for standardized protocols and external validation to ensure clinical applicability.