Helicobacter pylori infection is linked to metabolic dysfunction and associated steatotic liver disease: A large cross-sectional study

BACKGROUND

Helicobacter pylori (H. pylori), a globally widespread pathogen affecting half of the global population, has been increasingly implicated in metabolic disorders, including obesity, dyslipidemia, and metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD is a common condition, impacting nearly one in four adults globally. It also shares significant pathophysiological links with metabolic syndrome. Despite the fact that mechanistic hypotheses (such as oxidative stress and inflammation) have been proposed to explain these relationships, large-scale studies comprehensively assessing multifactorial metabolic associations are lacking. We proposed that H. pylori infection may independently correlate with unfavorable metabolic profiles and the presence of MASLD among adults in a large cohort.

AIM

To investigate the associations of H. pylori infection with obesity, glucose, lipids, blood pressure, and MASLD in Chinese adults.

METHODS

This study included 28624 adults recruited from the Physical Examination Center at Nanchang University's Second Affiliated Hospital. The 13C-urea breath test was used to identify H. pylori infection, while abdominal ultrasound was employed for MASLD diagnosis. The relationships between H. pylori infection and metabolic factors were analyzed via multivariate logistic regression.

RESULTS

The overall H. pylori infection incidence was 26.8%, with higher rates observed in older adults (≥ 70 years: 26.1% vs 18-29 years: 24.6%, P < 0.001) and obese individuals [body mass index (BMI) ≥ 28 kg/m²: 30.0% vs normal BMI: 25.3%, P < 0.001]. H. pylori-positive individuals exhibited elevated blood glucose (5.43 ± 1.55 mmol/L vs 5.27 ± 1.23 mmol/L, P < 0.001), low-density lipoprotein cholesterol (2.97 ± 0.76 mmol/L vs 2.94 ± 0.75 mmol/L, P < 0.001), and blood pressure (systolic: 123.49 ± 19.06 mmHg vs 122.85 ± 18.33 mmHg, P = 0.009; diastolic: 75.48 ± 12.37 vs 74.9 mmHg ± 11.9 mmHg, P < 0.001) levels. Among MASLD patients, infection was associated with increased glucose (5.82 ± 1.95 mmol/L vs 5.60 ± 1.60 mmol/L, P < 0.001), total cholesterol (5.05 ± 1.03 mmol/L vs 5.00 ± 1.00 mmol/L, P = 0.039), BMI (26.23 ± 3.00 kg/m² vs 26.04 ± 2.96 kg/m², P = 0.004), and blood pressure (systolic: 129.5 ± 20.00 mmHg vs 128.49 ± 17.62 mmHg, P = 0.009; diastolic: 79.87 ± 12.07 mmHg vs 79.04 ± 11.76 mmHg, P = 0.002) levels. Multivariate analysis demonstrated elevated glucose [odds ratio (OR) = 1.079, P < 0.001], BMI (OR = 1.016, P = 0.002), and diastolic pressure (OR = 1.003, P = 0.048) levels as independent risk factors, with high-density lipoprotein (HDL) being observed as a protective factor (OR = 0.837, P < 0.001).

CONCLUSION

H. pylori infection correlates with older age, obesity, elevated glucose levels, and elevated diastolic blood pressure, whereas HDL protects against H. pylori infection, thus underscoring its role in metabolic disturbances and MASLD.

Nonalcoholic fatty liver disease following laparoscopic duodenum-preserving pancreatic total head resection vs laparoscopic pancreaticoduodenectomy: A retrospective cohort study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol. Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy (LPD) have been identified. This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection (LDPPHRt) and LPD.

AIM

To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.

METHODS

This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery (LDPPHRt or LPD) between May 2020 and April 2023. Patient data on perioperative and postoperative variables were analyzed and compared. Multivariate logistic regression was used to identify pre-, peri-, and postoperative risk factors for NAFLD, with statistical significance set at P < 0.05.

RESULTS

Of the 59 patients included in the study, 17 (28.8%) developed NAFLD within 6-12 months post-surgery. The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group (40.0% vs 12.5%, P = 0.022). Multivariable analysis identified the LDPPHRt surgical approach (compared to LPD) as an independent protective factor against the development of postoperative NAFLD, with an odds ratio of 0.208 (95% confidence interval: 0.046-0.931; P = 0.040).

CONCLUSION

Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD, which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.

Altered microbiota of rectal mucosa in rectal cancer patients

BACKGROUND

With advances in sequencing techniques, microbiota dysbiosis and pathogenic microbes that accelerate colorectal cancer progression have been identified and widely reported. However, few studies have focused on the microbiota taxa of rectal mucus in rectal cancer (RC) patients. Here, we analyzed the composition and characteristics of the rectal mucosa microbiota of RC patients from Wenzhou city, China, and compared the results with those of healthy controls.

AIM

To explore the changes in the characteristics of the rectal mucosal flora associated with RC, and identify biomarkers of microbe taxa for RC.

METHODS

Rectal mucosa samples from a Chinese cohort of 72 recently diagnosed RC patients and 71 healthy controls were obtained. A validation cohort, which included 22 RC patients and 60 healthy controls, was also established. Changes in the rectal mucosal flora were observed by cultivation, 16S ribosomal DNA gene sequencing analysis and quantitative polymerase chain reaction analysis.

RESULTS

The 16S ribosomal DNA results demonstrated that RC patients presented increased bacterial community richness and alpha diversity as well as an altered rectal mucosal microbiota, with depletion of Proteobacteria and Thermi and enrichment of Bacteroidetes and Fusobacteria in cancerous mucosal tissues (CM) and enrichment of Firmicutes and Cyanobacteria in adjacent noncancerous mucosal tissues (AM). The culture results showed that the mean loads of Escherichia coli, Bifidobacterium, Enterococcus, and Lactobacillus were significantly reduced in RC patients. The ratios of Prevotella to Ruminococcus [areas under the receiver operating curve: 0.795 in AM vs normal control mucosa (NM), 0.77 in CM vs NM] and of Prevotella stercorea to Propionibacterium acnes (areas under the receiver operating curve: 0.808 in AM vs NM, 0.843 in CM vs NM) exhibited excellent abilities to differentiate between healthy controls and RC patients.

CONCLUSION

RC patients have an altered rectal mucosal microbiota, and the ratio of Prevotella to Ruminococcus or the ratio of Prevotella stercorea to Propionibacterium acnes may serve as a marker for RC diagnosis.

Noninvasive prediction of esophagogastric varices in hepatitis B: An extreme gradient boosting model based on ultrasound and serology

BACKGROUND

Severe esophagogastric varices (EGVs) significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage. Endoscopy is the gold standard for EGV detection but it is invasive, costly and carries risks. Noninvasive predictive models using ultrasound and serological markers are essential for identifying high-risk patients and optimizing endoscopy utilization. Machine learning (ML) offers a powerful approach to analyze complex clinical data and improve predictive accuracy. This study hypothesized that ML models, utilizing noninvasive ultrasound and serological markers, can accurately predict the risk of EGVs in hepatitis B patients, thereby improving clinical decision-making.

AIM

To construct and validate a noninvasive predictive model using ML for EGVs in hepatitis B patients.

METHODS

We retrospectively collected ultrasound and serological data from 310 eligible cases, randomly dividing them into training (80%) and validation (20%) groups. Eleven ML algorithms were used to build predictive models. The performance of the models was evaluated using the area under the curve and decision curve analysis. The best-performing model was further analyzed using SHapley Additive exPlanation to interpret feature importance.

RESULTS

Among the 310 patients, 124 were identified as high-risk for EGVs. The extreme gradient boosting model demonstrated the best performance, achieving an area under the curve of 0.96 in the validation set. The model also exhibited high sensitivity (78%), specificity (94%), positive predictive value (84%), negative predictive value (88%), F1 score (83%), and overall accuracy (86%). The top four predictive variables were albumin, prothrombin time, portal vein flow velocity and spleen stiffness. A web-based version of the model was developed for clinical use, providing real-time predictions for high-risk patients.

CONCLUSION

We identified an efficient noninvasive predictive model using extreme gradient boosting for EGVs among hepatitis B patients. The model, presented as a web application, has potential for screening high-risk EGV patients and can aid clinicians in optimizing the use of endoscopy.

Artificial intelligence-aided optical biopsy improves the diagnosis of esophageal squamous neoplasm

BACKGROUND

Early detection of esophageal squamous neoplasms (ESN) is essential for improving patient prognosis. Optical diagnosis of ESN remains challenging. Probe-based confocal laser endomicroscopy (pCLE) enables accurate in vivo histological observation and optical biopsy of ESN. However, interpretation of pCLE images requires histopathological expertise and extensive training. Artificial intelligence (AI) has been widely applied in digestive endoscopy; however, AI for pCLE diagnosis of ESN has not been reported.

AIM

To develop a pCLE computer-aided diagnostic system for ESN and assess its diagnostic performance and assistant efficiency for nonexpert endoscopists.

METHODS

The intelligent confocal laser endomicroscopy (iCLE) system consists of image recognition (based on inception-ResNet V2), video diagnosis, and quality judgment modules. This system was developed using pCLE images and videos and evaluated through image and prospective video recognition tests. Patients between June 2020 and January 2023 were prospectively enrolled. Expert and non-expert endoscopists and the iCLE independently performed diagnoses for pCLE videos, with histopathology as the gold standard. Thereafter, the non-expert endoscopists performed a second assessment with iCLE assistance.

RESULTS

A total of 25056 images from 2803 patients were selected for iCLE training and validation. Another 2442 images from 226 patients were used for testing. iCLE achieved a high accuracy of 98.3%, sensitivity of 95.3% and specificity of 98.8% for diagnosing ESN images. A total of 2581 patients underwent upper gastrointestinal pCLE examination and were prospectively screened; 54 patients with suspected ESN were enrolled. Overall, 187 videos from 67 lesions were assessed by iCLE, three nonexpert and three expert endoscopists. iCLE achieved a high accuracy, sensitivity and specificity of 90.9%, 92.0%, and 90.2%, respectively. Compared to experts, iCLE showed significantly higher sensitivity (92.0% vs 80.4%; P < 0.001) and negative predictive value (94.4% vs 87.7%; P = 0.003). With iCLE assistance, nonexpert endoscopists showed significant improvements in accuracy (from 83.6% to 88.6%) and sensitivity (from 76.0% to 89.8%).

CONCLUSION

iCLE system demonstrated high diagnostic performance for ESN. It can assist nonexpert endoscopists in improving the diagnostic efficiency of pCLE for ESN and has the potential for reducing unnecessary biopsies.

Role of gut microbiota and mesenteric adipose tissue in the pathology of Crohn’s disease: Potential therapeutic targets

This editorial comments on the article by Wu et al in the World Journal of Gastroenterology. The article explored the relationship between mesenteric adipose tissue, creeping fat, inflammation, and gut microbiota in Crohn’s disease (CD). We discussed three key aspects of the interaction between gut microbiota and inflammatory bowel disease (IBD): The physiological functions of the gut microbiota, the potential role of probiotics in IBD treatment; and the effect of fecal microbiota transplantation (FMT) in combating IBD. IBD, comprising CD and ulcerative colitis (UC), is influenced by the gut microbiota. Changes in gut microbiota composition disrupt intestinal function and promote chronic inflammation, but the exact mechanisms remain unclear. Probiotics have demonstrated some efficacy in inducing remission in UC, though their effectiveness in CD is still debated. FMT shows promise in treating IBD, especially UC, by restoring gut microbiota diversity and inducing clinical remission. As for CD, FMT has potential, but more studies are needed to confirm its long-term effectiveness and safety. Dietary approaches may help manage IBD symptoms or disease activity, but patient adherence is crucial. Clinicians and researchers must recognize the importance of the gut microbiota and the need for personalized therapies targeting microbial imbalances.

Long noncoding RNA semaphorin 6A-antisense RNA 1 reduces hepatocellular carcinoma by promoting semaphorin 6A mRNA degradation

BACKGROUND

Hepatocellular carcinoma (HCC) is a prevalent malignant tumor with a poor prognosis, which is often associated with chronic hepatitis B virus infection in China. Our previous study has shown that long non-coding RNA semaphorin 6A-antisense RNA 1 (SEMA6A-AS1) was significantly downregulated in hepatitis B virus-related HCC and associated with poor prognosis.

AIM

To explore the underlying mechanism of SEMA6A-AS1 in HCC progression.

METHODS

The expression levels of SEMA6A-AS1 and SEMA6A were detected using quantitative polymerase chain reaction, immunohistochemistry and Western blot. A growth curve, colony formation, wound-healing and transwell (with or without Matrigel) assays were respectively performed to assess the proliferation, migration and invasion abilities of HCC cells. Cell cycle and apoptosis assays were performed by flow cytometry. To investigate the potential mechanism underpinning SEMA6A-AS1, we utilized tagged RNA affinity purification, dual luciferase reporter assay and immunofluorescence.

RESULTS

Downregulation of SEMA6A-AS1 in HCC was negatively correlated with SEMA6A protein expression. SEMA6A was upregulated in HCC and correlated with high alpha-fetoprotein level, high Edmondson-Steiner grade and poor prognosis. SEMA6A-AS1 significantly inhibited the proliferation, migration and invasion of HCC cells by combining with SEMA6A mRNA and promoting its degradation. SEMA6A protein promoted the proliferation, migration and invasion of HCC cells by regulating the actin cytoskeleton.

CONCLUSION

Our findings suggest that SEMA6A-AS1 can inhibit HCC progression through decreasing SEMA6A expression by promoting its mRNA degradation. SEMA6A-AS1 may be a prognostic biomarker and therapeutic target for HCC.

Suppressor of cytokine signaling 2 modulates regulatory T cell activity to suppress liver hepatocellular carcinoma growth and metastasis

BACKGROUND

Liver hepatocellular carcinoma (LIHC) is a highly aggressive cancer with poor prognosis due to its complex tumor microenvironment (TME) and immune evasion. Regulatory T cells (Tregs) play a critical role in tumor progression. Suppressor of cytokine signaling 2 (SOCS2), a key immune regulator, may modulate Treg activity and impact LIHC growth and metastasis.

AIM

To explore how the SOCS2 affects Treg activity in LIHC and its impact on tumor growth and metastasis.

METHODS

LIHC transcriptome data from The Cancer Genome Atlas database were analyzed using Gene Set Enrichment Analysis, Estimation of Stromal and Immune Cells in Malignant Tumors Using Expression Data, and Cell-Type Identification by Estimating Relative Subsets of RNA Transcripts to evaluate immune pathways and Treg infiltration. Key prognostic genes were identified using Weighted Gene Co-expression Network Analysis and machine learning. In vitro, co-culture experiments, migration assays, apoptosis detection, and enzyme-linked immunosorbent assay were conducted. In vivo, tumor growth, metastasis, and apoptosis were assessed using subcutaneous and lung metastasis mouse models with hematoxylin and eosin staining, Terminal Deoxynucleotidyl Transferase dUTP Nick End Labeling, and immunohistochemistry analyses.

RESULTS

SOCS2 overexpression inhibited Treg cell activity, reducing LIHC cell migration and invasion while increasing apoptosis. In vivo, SOCS2 suppressed tumor growth and metastasis, confirming its therapeutic potential.

CONCLUSION

SOCS2 modulates CD4⁺ T function in the TME, contributing to LIHC progression. Targeting SOCS2 presents a potential therapeutic strategy for treating LIHC.

Amoxicillin high-dose dual therapy for Helicobacter pylori primary eradication: Proton pump inhibitor and potassium-competitive acid blocker, which’s better?

BACKGROUND

Effective acid suppression significantly enhances the eradication rate of Helicobacter pylori (H. pylori).

AIM

To assess the efficacy and safety of high-dose dual therapy (HDDT) utilizing various highly potent antisecretory medications, thereby providing additional clinical guidance for H. pylori eradication.

METHODS

The study population comprised untreated H. pylori patients from three medical centers in central China. From February 10, 2024 to March 31, 2024, 439 subjects were randomly allocated to either the esomeprazole-amoxicillin (EA) or esomeprazole-amoxicillin-clarithromycin-bismuth (B-quadruple) group. Subsequently, from April 1, 2024 to May 10, 2024, 367 subjects were randomly assigned to either the vonoprazan-amoxicillin (VA) or vonoprazan-amoxicillin-clarithromycin (VAC) group. The study recorded treatment efficacy, adverse events, compliance, symptom alleviation, and associated costs.

RESULTS

EA-dual demonstrated non-inferiority to B-quadruple regimen in modified intention-to-treat (mITT) and per-protocol (PP) analyses (P < 0.025). However, the eradication rate of EA was lower than that of the B-quadruple group [70.59% vs 83.49%, 92.86% vs 98.38%, 93.94% vs 98.38%, intention-to-treat (ITT), mITT, PP respectively, P < 0.05]. In ITT, mITT, and PP analyses, VA-dual was non-inferior to VAC treatment (84.15% vs 83.15%, 96.25% vs 92.73%, 96.75% vs 93.75%, P < 0.025). No significant differences were observed in adverse events, compliance, and symptom relief between groups. VA exhibited the lowest cost. Antibiotic use within 2 years, poor compliance, and suburban residence were associated with reduced eradication efficacy (P < 0.05).

CONCLUSION

The HDDT based on vonoprazan demonstrated non-inferiority to the VAC triple regimen, suggesting its potential as a recommended first-line treatment for H. pylori eradication. While B-quadruple therapy showed better eradication rate than EA therapy, the latter proved non-inferior in mITT and PP analyses. Notably, antibiotic use within the preceding two years, adherence to treatment protocols, and patient residence emerged as critical factors influencing eradication success.

Towards personalized care in minimally invasive esophageal surgery: An adverse events prediction model

This letter addressed the impactful study by Zhong et al, which introduced a risk prediction and stratification model for surgical adverse events following minimally invasive esophagectomy. By identifying key risk factors such as chronic obstructive pulmonary disease and hypoalbuminemia, the model demonstrated strong predictive accuracy and offered a pathway to personalized perioperative care. This correspondence highlighted the clinical significance, emphasizing its potential to optimize patient outcomes through tailored interventions. Further prospective validation and application across diverse settings are essential to realize its full potential in advancing esophageal surgery practices.

Targeting mixed lineage kinase domain-like protein's non-necroptosis role: A new horizon in anti-inflammatory therapy for alcoholic liver disease

Although mixed lineage kinase domain-like protein (MLKL) is widely recognized as a critical effector in the necroptotic signaling pathway, MLKL plays broader regulatory roles beyond programmed necroptosis. Notably, Xuan Yuan et al demonstrated that CPD4, an ATP-binding pocket inhibitor of MLKL, significantly reduces liver inflammation and improves liver function by inhibiting NF-κB signaling, suggesting its use as a potential therapeutic candidate for alcoholic liver disease. However, the pharmacokinetic properties and long-term toxicity of CPD4 require further evaluation. Moreover, a single therapeutic strategy targeting MLKL may not be sufficient. Future studies should focus on the precise regulation of MLKL and develop combination therapies to achieve dual intervention of inflammatory and cell death pathways. This paper provides an important theoretical foundation for translational research on MLKL-targeted therapy. However, its clinical translation requires overcoming existing limitations and further elucidating the regulatory network of MLKL in complex microenvironments.

Machine learning-based reconstruction of prognostic staging for gastric cancer patients with different differentiation grades: A multicenter retrospective study

BACKGROUND

The prognosis of gastric cancer (GC) patients is poor, and an accurate prognostic staging system would help assess patients' prognostic status before treatment and determine appropriate treatment strategies.

AIM

To develop positive lymph node ratio (LNR) and machine learning (ML)-based staging systems for GC patients with varying differentiation.

METHODS

This multicenter retrospective cohort study included 11772 GC patients, with 5612 in the training set (Harbin Medical University Cancer Hospital) and 6160 in the validation set (Surveillance, Epidemiology, and End Results Program database). X-tile software identified optimal cutoff values for the positive LNR, and five ML models were developed using pT and LNR staging. Risk scores were divided into seven stages, constructing new staging systems tailored to different tumor differentiation levels.

RESULTS

In both the training and validation sets, regardless of the tumor differentiation level, LNR staging demonstrated superior prognostic stratification compared to pN. Extreme Gradient Boosting exhibited better predictive performance than the other four models. Compared to tumor node metastasis staging, the new staging systems, developed for patients with different degrees of differentiation, showed significantly better predictive performance.

CONCLUSION

The new positive lymph nodes ratio staging and integrated staging systems constructed for GC patients with different differentiation grades exhibited better prognostic stratification capabilities.

Endoplasmic reticulum stress in gut inflammation: Implications for ulcerative colitis and Crohn’s disease

Eukaryotic cells contain the endoplasmic reticulum (ER), a prevalent and intricate membranous structural system. During the development of inflammatory bowel disease (IBD), the stress on the ER and the start of the unfolded protein response are very important. Some chemicals, including 4μ8C, small molecule agonists of X-box binding protein 1, and ISRIB, work on the inositol-requiring enzyme 1, turn on transcription factor 6, and activate protein kinase RNA-like ER kinase pathways. This may help ease the symptoms of IBD. Researchers investigating the gut microbiota have discovered a correlation between ER stress and it. This suggests that changing the gut microbiota could help make new medicines for IBD. This study looks at how ER stress works and how it contributes to the emergence of IBD. It also talks about its possible clinical importance as a therapeutic target and looks into new ways to treat this condition.

Reduced interleukin-2 receptor subunit γ expression in Crohn's disease: A potential mechanism for γδ T cell deficiency

Crohn’s disease (CD) is a chronic inflammatory disorder characterized by dysregulated immune responses and significant disruption of intestinal immunity. A recent case-control study by Andreu-Ballester et al revealed decreased expression of interleukin (IL)-2 receptor subunit γ (CD132) in CD tissues, a finding that has profound implications for understanding immune dysregulation in CD. CD132, an essential component of the IL-7/IL-2 signaling axis, is critical for γδ T cell survival and function, which are pivotal for maintaining gut integrity and modulating inflammation. Here, we propose that reduced CD132 expression represents a key mechanism underlying γδ T cell deficiencies in CD, contributing to impaired immune surveillance and exacerbated inflammation. This hypothesis integrates emerging evidence from cytokine signaling and immunopathology in CD, offering new insights into its pathogenesis. These findings highlight the therapeutic potential of targeting the IL-7/IL-2 axis to restore immune homeostasis in CD, presenting a novel avenue for future research and intervention.

Characterization of gallbladder stones associated with occult pancreaticobiliary reflux using computed tomography

BACKGROUND

Occult pancreaticobiliary reflux (OPBR) is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladder stones.

AIM

To explore the computed tomography (CT) imaging characteristics of gallbladder stones in patients diagnosed with OPBR.

METHODS

We analyzed 362 patients undergoing cholecystectomy (November 2020 to January 2022). Intraoperative bile samples were assayed for amylase (> 110 U/L indicated OPBR). CT features, including stone density and visibility, were compared between 54 OPBR and 308 controls. Stone attenuation (HU) was measured under standardized conditions (uCT-780, 120 kVp, 160 mAs). Logistic regression and receiver operating characteristic curve analysis identified independent OPBR predictors, forming a validated nomogram.

RESULTS

OPBR patients exhibited significantly higher rates of CT-invisible stones (35.2% vs 12.3%) and uniform stones (87% vs 73.1%) along with lower overall stone density (P = 0.01). Logistic regression identified stone visibility, uniformity, and density as independent predictors. A nomogram integrating these features with patient age achieved high diagnostic accuracy (area under the curve = 0.71).

CONCLUSION

CT imaging distinctly identifies gallbladder stone density, indicating a heightened risk of OPBR in patients with uniform and CT-invisible stones. Such imaging is crucial for preoperative assessments to evaluate potential recurrent biliary pathologies post-cholecystectomy.

Liver transplantation improves prognosis across all grades of acute-on-chronic liver failure patients: A systematic review and meta-analysis

BACKGROUND

Liver transplantation (LT) is recognized as an effective approach that offers survival benefits for patients with acute-on-chronic liver failure (ACLF). However, controversies remain regarding the LT selection criteria, and meta-analyses reporting overall survival outcomes across different ACLF severity grades are lacking.

AIM

To depict a comprehensive postoperative picture of patients with ACLF of varying severity and contribute to updating LT selection.

METHODS

Systematic searches in Web of Science, EMBASE, PubMed, and Cochrane databases were performed, from inception to December 26, 2023, for studies exploring post-transplant outcomes among ACLF patients, stratified by severity grades as identified by the European Association for the Study of the Liver-Chronic Liver Failure criteria. The primary outcome of interest was the survival rate within one year, with post-transplant complications as secondary outcomes. Additionally, the subgroup analysis examined region-specific one-year survival rates.

RESULTS

A total of 17 studies involving 28025 participants were included. Patients with ACLF-1 and ACLF-2 have favorable survival within one year, with survival rates reaching 87% [95% confidence interval (CI): 84%-91%] and 86% (95%CI: 81%-91%), respectively. Despite the relatively lower survival (73%, 95%CI: 66%-80%) and higher incidence of infection (48%, 95%CI: 29%-67%) observed in ACLF-3 patients, their survival exceeds that of those who do not undergo LT. Moreover, post-transplant survival was highest in North America across all ACLF grades.

CONCLUSION

LT can provide survival advantages for ACLF patients. To optimize the utilization of scarce donor organs and improve prognosis, comprehensive preoperative health evaluations are essential, especially for ACLF-3 patients.

Facing the challenges of autoimmune pancreatitis diagnosis: The answer from artificial intelligence

Current diagnosis of autoimmune pancreatitis (AIP) is challenging and often requires combining multiple dimensions. There is a need to explore new methods for diagnosing AIP. The development of artificial intelligence (AI) is evident, and it is believed to have potential in the clinical diagnosis of AIP. This article aims to list the current diagnostic difficulties of AIP, describe existing AI applications, and suggest directions for future AI usages in AIP diagnosis.

Randomized study of Lacticaseibacillus fermented milk in Indonesian elderly houses: Impact on gut microbiota and gut environment

BACKGROUND

Health maintenance in elderly houses includes management of the gut microbiota and the environment. Lacticaseibacillus paracasei Shirota (LcS) is a probiotic strain that positively affects the human gut. However, the evidence of its effects on the Indonesian population remains limited.

AIM

To investigate the effect of LcS-fermented milk on the gut microbiota and environment of Indonesian elderly houses.

METHODS

This double-blind, randomized, placebo-controlled trial involved 112 participants from Indonesian elderly houses, spanning a 2-week baseline and 24-week treatment. Participants were randomly assigned to probiotic or placebo groups, consuming fermented milk with or without LcS (> 6.5 × 10⁹ colony-forming units). Fecal samples were collected every three months. Gut microbiota analysis was performed using 16S rRNA gene sequencing and reverse transcription quantitative polymerase chain reaction, while gut environment was assessed by measuring fecal organic acids, amino acid metabolites, and stool frequency.

RESULTS

Analyses of 16S rRNA gene sequence data at the 3-month period revealed increased Bifidobacterium and Succinivibrio and decreased Rikenellaceae RC9 gut group in the probiotic group. These shifts were associated with significant differences in β-diversity metrics. The change in Bifidobacterium was confirmed by reverse transcription quantitative polymerase chain reaction, demonstrating higher abundance in the probiotic group than in the placebo group (8.5 ± 1.1 vs 8.0 ± 1.1, log₁₀ bacterial cells/g; P = 0.044). At 6-month period, the differences in Succinivibrio and Rikenellaceae RC9 gut group persisted. The probiotic group showed higher butyrate levels than the placebo group at the 6-month period (5.04 ± 3.11 vs 3.95 ± 2.89, μmol/g; P = 0.048). The effect on amino acid metabolites and stool frequency was not significant.

CONCLUSION

Daily intake of LcS positively affects the gut microbiota and environment of people living in Indonesian elderly houses.

Decreased gene expression of interleukin 2 receptor subunit γ (CD132) in tissues of patients with Crohn’s disease

BACKGROUND

A deficiency of γδ T cells has been described in Crohn's disease (CD).

AIM

To analyze the gene expression of interleukin 7 (IL-7) and its receptors in the tissues of patients with CD.

METHODS

We studied the peripheral blood of 80 patients with CD, comparing them with a group of 80 healthy subjects. The number and apoptosis of αβ and γδ T cells in peripheral blood and the proportion of αβ and γδ T cells in the intestinal tissues of patients with CD (n = 25) were studied. The gene and protein expression of IL-7, IL-2 receptor subunit γ [cluster of differentiation 132 (CD132)], receptor α (CD127), and caspase-3 in tissues was analyzed by quantitative PCR. Serum IL-7 levels were also analyzed.

RESULTS

In patients with CD, a decreased number of γδ T cells and an increase in the apoptosis of CD56+ αβ and γδ T cells in peripheral blood was observed (P < 0.0001 and P < 0.01) respectively, and there was an inverse correlation among T subsets and their apoptosis. In addition, IL-7 gene expression and IL-7 protein in the tissues of these patients were increased. The titers of caspase-3 in tissues were low vs control group (P > 0.01). The percentage of CD8+γδ T cells decreased in tissues (P < 0.01), and was directly related to IL-7 levels in peripheral blood. The expression of IL-2 receptor subunit γ (CD132) was greatly decreased in the tissues of patients with CD (P < 0.05).

CONCLUSION

There may be a cause-effect relationship between the lower gene expression of the IL-2 receptor subunit γ (CD132) in tissues of patients with CD and γδ T cells immunodeficiency.

Antibiotic resistance of Helicobacter pylori and related risk factors in Hunan Province: A multicenter study

BACKGROUND

Antibiotic resistance is a key factor influencing the treatment outcomes of Helicobacter pylori (H. pylori) infection. The antibiotic resistance spectrum of H. pylori varies in different regions. We investigated the current status of antibiotic resistance of H. pylori in Hunan Province and analyzed the factors related to such resistance to provide strategies for the accurate clinical treatment of H. pylori infection.

AIM

To understand the antibiotic resistance of H. pylori in Hunan Province and provide guidance for the clinical treatment of H. pylori infection.

METHODS

This study selected patients who underwent gastroscopy in five hospitals in Hunan Province from April 2022 to April 2023. The sensitivity of H. pylori to clarithromycin, levofloxacin, metronidazole, amoxicillin, furazolidone, and tetracycline was detected using the Agar dilution method.

RESULTS

H. pylori strains from a total of 566 patients were isolated and identified. The resistance rates of H. pylori strains to clarithromycin, levofloxacin, metronidazole, amoxicillin, furazolidone, and tetracycline were 49.2%, 37.8%, 76.1%, 2.3%, 1.4%, and 0.7%, respectively. The resistance rates to clarithromycin, levofloxacin, and metronidazole were high in the four regions of Hunan Province, and the overall resistance rates in central Hunan Province were higher than those in other regions. The resistance rates of H. pylori strains to clarithromycin and levofloxacin were significantly different among the different age groups (P < 0.05), with the elderly group having a higher resistance rate than the young group. The resistance rate of H. pylori strains to clarithromycin was greater in patients with atrophic gastritis, and the resistance rate to levofloxacin was the lowest in patients with peptic ulcers.

CONCLUSION

The resistance rate of H. pylori to amoxicillin, clarithromycin, and metronidazole is high in Hunan Province. Age, stomach disease, and H. pylori reinfection may affect the antibiotic resistance of H. pylori.

Involvement of the NLRP3/IL-1β pathway in activation and effector functions of γδT17 cells in patients with ulcerative colitis

BACKGROUND

The interleukin-17 (IL-17) mediated aberrant immune-inflammatory response plays a paramount role in ulcerative colitis (UC). γδT17 cells are one of the critical sources of IL-17, but the role they play in UC remains under debate.

AIM

To clarify the role of γδT17 cells in patients with mild-to-moderate UC.

METHODS

A single-centre observational pragmatic study was conducted on patients with UC who attended the outpatient and inpatient departments of Xiyuan Hospital of the China Academy of Traditional Chinese Medicine from September 2020 to December 2022. The research population consisted of two groups of adult patients. The first group consisted of healthy volunteers with no significant abnormalities on colonoscopy, and the other group consisted of patients with mild-to-moderate ulcerative colitis. Serum samples from healthy volunteers and patients with UC were collected for the detection of relevant inflammatory factors. Moreover, five colon mucosa samples were randomly selected from each group for testing and analyses.

RESULTS

An increased number of γδT17 cells and hyperactivation of the NLR family pyrin domain containing 3/IL-1β signaling pathway were observed in colonic mucosal tissues from patients with UC.

CONCLUSION

Hyperactivation of the NLR family pyrin domain containing 3/IL-1β signaling pathway promotes the activation of γδT17 cells in colonic mucosal tissues of patients with UC.

Peroral endoscopic myotomy for achalasia and patients with normal lower-esophageal-sphincter integrated relaxation pressure: A propensity-score-matched retrospective study

BACKGROUND

Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter (LES) pressure. Peroral endoscopic myotomy (POEM) has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.

AIM

To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure (LES-IRP).

METHODS

The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed. A total of 481 patients who underwent preoperative high-resolution manometry (HRM) at our hospital were ultimately included in this research. According to the HRM results, the patients were divided into two groups: 71 patients were included in the normal LES-IRP group (LES-IRP < 15 mmHg) and 410 patients were included in the increased LES-IRP group (LES-IRP ≥ 15 mmHg). Clinical characteristics, procedure-related parameters, adverse events, and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.

RESULTS

Among the 481 patients included in our study, 209 were males and 272 were females, with a mean age of 44.2 years. All patients underwent POEM without severe adverse events. The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0 (P = 0.132), respectively, decreasing to 1.0 and 1.0 post-treatment (P = 0.572). The clinical success rate of the normal LES-IRP group was 87.3% (62/71), and that of the increased LES-IRP group was 91.2% (374/410) (P = 0.298). Reflux symptoms were measured by the GerdQ questionnaire, and the percentages of patients with GerdQ scores ≥ 9 in the normal LES-IRP and increased LES-IRP groups were 8.5% and 10.7%, respectively (P = 0.711). After matching, the rates of clinical success and the rates of GerdQ score ≥ 9 were not significantly different between the two groups.

CONCLUSION

Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP. In addition, in patients with normal LES-IRP, compared with those with increased LES-IRP, POEM was not associated with a greater incidence of reflux symptoms.

scRNA-seq of the intestine reveals the key role of mast cells in early gut dysfunction associated with acute pancreatitis

BACKGROUND

Intestinal barrier dysfunction is a prevalent and varied manifestation of acute pancreatitis (AP). Molecular mechanisms underlying the early intestinal barrier in AP remain poorly understood.

AIM

To explore the biological processes and mechanisms of intestinal injury associated with AP, and to find potential targets for early prevention or treatment of intestinal barrier injury.

METHODS

This study utilized single-cell RNA sequencing of the small intestine, alongside in vitro and in vivo experiments, to examine intestinal barrier function homeostasis during the early stages of AP and explore involved biological processes and potential mechanisms.

RESULTS

Seventeen major cell types and 33232 cells were identified across all samples, including normal, AP1 (4x caerulein injections, animals sacrificed 2 h after the last injection), and AP2 (8x caerulein injections, animals sacrificed 4 h after the last injection). An average of 980 genes per cell was found in the normal intestine, compared to 927 in the AP1 intestine and 1382 in the AP2 intestine. B cells, dendritic cells, mast cells (MCs), and monocytes in AP1 and AP2 showed reduced numbers compared to the normal intestine. Enterocytes, brush cells, enteroendocrine cells, and goblet cells maintained numbers similar to the normal intestine, while cytotoxic T cells and natural killer (NK) cells increased. Enterocytes in early AP exhibited elevated programmed cell death and intestinal barrier dysfunction but retained absorption capabilities. Cytotoxic T cells and NK cells showed enhanced pathogen-fighting abilities. Activated MCs, secreted chemokine (C-C motif) ligand 5 (CCL5), promoted neutrophil and macrophage infiltration and contributed to barrier dysfunction.

CONCLUSION

These findings enrich our understanding of biological processes and mechanisms in AP-associated intestinal injury, suggesting that CCL5 from MCs is a potential target for addressing dysfunction.

Perirenal fat area is a preoperative predictor of hypertension resolution after laparoscopic sleeve gastrectomy: Generalized additive models

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) can lead to complete resolution of hypertension in most patients with obesity within one year. However, the preoperative factors related to this resolution are still unclear.

AIM

To clarify the impact of relevant factors, particularly perirenal fat, on postoperative hypertension resolution.

METHODS

In this retrospective single-center study, a total of 138 patients with obesity and hypertension were included, all of whom underwent LSG in the hospital and were followed up for one year. Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution. Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution, and their predictive values were compared using fivefold cross-validation.

RESULTS

After LSG, 107 patients (77.5%) experienced hypertension resolution, while 31 patients (22.5%) did not achieve resolution. Both the preoperative perirenal fat area (PrFA) and perirenal fat thickness were independent risk factors for postoperative hypertension resolution (P < 0.001 vs P = 0.002). These factors are curvilinearly correlated with the hypertension resolution rate, but PrFA has a better predictive value than perirenal fat thickness dose (area under the curve = 0.846 vs 0.809). Compared with those with PrFA ≥ 18 cm², patients with PrFA < 18 cm² had a higher hypertension resolution rate [87% vs 68.1%; odds ratio (95% confidence interval) = 3.513 (1.367-9.902), P = 0.012].

CONCLUSION

PrFA is a preoperative predictor of postoperative hypertension resolution. It is curvilinearly associated with the resolution rate, and patients with PrFA < 18 cm² have better hypertension resolution outcomes after LSG.

Ligation-assisted endoscopic submucosal resection following the unroofing technique for esophageal lesions

For the treatment method of esophageal subepithelial lesions originating from the muscularis propria, conventional endoscopic resection techniques are time-consuming and lack efficacy for small subepithelial lesions originating from the muscularis propria. Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection, aiming to provide a minimally invasive method for treatment. We discussed and analyzed this study from the aspects of sample screening, clinical pathological characteristics, case-control analysis, and follow-up data.