Effects of artificial intelligence assistance on endoscopist performance: Comparison of diagnostic performance in superficial esophageal squamous cell carcinoma detection using video-based models

Objectives

Superficial esophageal squamous cell carcinoma (ESCC) detection is crucial. Although narrow-band imaging improves detection, its effectiveness is diminished by inexperienced endoscopists. The effects of artificial intelligence (AI) assistance on ESCC detection by endoscopists remain unclear. Therefore, this study aimed to develop and validate an AI model for ESCC detection using endoscopic video analysis and evaluate diagnostic improvements.

Methods

Endoscopic videos with and without ESCC lesions were collected from May 2020 to January 2022. The AI model trained on annotated videos and 18 endoscopists (eight experts, 10 non-experts) evaluated their diagnostic performance. After 4 weeks, the endoscopists re-evaluated the test data with AI assistance. Sensitivity, specificity, and accuracy were compared between endoscopists with and without AI assistance.

Results

Training data comprised 280 cases (140 with and 140 without lesions), and test data, 115 cases (52 with and 63 without lesions). In the test data, the median lesion size was 14.5 mm (range: 1-100 mm), with pathological depths ranging from high-grade intraepithelial to submucosal neoplasia. The model's sensitivity, specificity, and accuracy were 76.0%, 79.4%, and 77.2%, respectively. With AI assistance, endoscopist sensitivity (57.4% vs. 66.5%) and accuracy (68.6% vs. 75.9%) improved significantly, while specificity increased slightly (87.0% vs. 91.6%). Experts demonstrated substantial improvements in sensitivity (59.1% vs. 70.0%) and accuracy (72.1% vs. 79.3%). Non-expert accuracy increased significantly (65.8% vs. 73.3%), with slight improvements in sensitivity (56.1% vs. 63.7%) and specificity (81.9% vs. 89.2%).

Conclusions

AI assistance enhances ESCC detection and improves endoscopists' diagnostic performance, regardless of experience.

Lymphadenectomy Does Not Improve Cancer-Specific Survival for Colorectal Cancer Patients Underwent Endoscopic Therapy: A Population-Based Retrospective Study

METHODS

A total of 6626 patients with CRC who were initially referred for endoscopic polypectomy were enrolled from the Surveillance Epidemiology and End Results Database.

Results: Most enrolled patients (6557/6626, 99.0%) were at T0-T1 stage (American Joint Committee on Cancer staging system). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to reduce selection bias, which resulted in balanced groups of patients with and without lymphadenectomy, with no difference in CSS (p = .99 and .074, respectively). In the subgroup analysis, insufficient lymphadenectomy (lymph node yield [LNY] < 12) was associated with poor CSS compared with no lymphadenectomy. The multivariate analysis identified adequate lymphadenectomy with an LNY ≥ 12 as an independent favorable prognostic factor. However, nearly half of the patients (59/127, 46.5%) referred for lymph node resection did not undergo adequate lymphadenectomy.

CONCLUSIONS

The prognosis of CSS cannot be improved by lymphadenectomy for most patients (T0-T1) who are referred for endoscopic therapy because of the low rate of lymph node metastasis. Nonetheless, adequate lymphadenectomy should be performed instead of diagnostic lymph node resection if lymph node involvement is suspected.

Artificial intelligence-assisted diagnosis of early gastric cancer: present practice and future prospects

Gastric cancer (GC) occupies the first few places in the world among tumors in terms of incidence and mortality, causing serious harm to human health, and at the same time, its treatment greatly consumes the health care resources of all countries in the world. The diagnosis of GC is usually based on histopathologic examination, and it is very important to be able to detect and identify cancerous lesions at an early stage, but some endoscopists' lack of diagnostic experience and fatigue at work lead to a certain rate of under diagnosis. The rapid and striking development of Artificial intelligence (AI) has helped to enhance the ability to extract abnormal information from endoscopic images to some extent, and more and more researchers are applying AI technology to the diagnosis of GC. This initiative has not only improved the detection rate of early gastric cancer (EGC), but also significantly improved the survival rate of patients after treatment. This article reviews the results of various AI-assisted diagnoses of EGC in recent years, including the identification of EGC, the determination of differentiation type and invasion depth, and the identification of borders. Although AI has a better application prospect in the early diagnosis of ECG, there are still major challenges, and the prospects and limitations of AI application need to be further discussed.

Intestinal and esophageal microbiota in esophageal cancer development and treatment

Esophageal cancer (EC) is the eleventh most commonly diagnosed cancer, and its prognosis remains poor. Several challenges remain for improving the clinical outcomes of EC, and improving technologies for early detection, diversifying treatment options, and advancing personalized treatment are essential. Alterations in the intestinal and esophageal microbiota are associated with the pathogenesis and progression of EC; for instance, Fusobacterium nucleatum is important in the pathogenesis and progression of esophageal squamous cell carcinoma. Therefore, a novel diagnostic biomarker may be identified using the intestinal microbiota. Furthermore, targeting the intestinal and esophageal microbiota may help in the early detection of EC, use of a novel prognostic biomarker, and even the detection of a therapeutic target, resulting in a more individualized therapeutic approach for EC. In this review, we summarize the clinical research focused on the intestinal and esophageal microbiota in EC development and its treatment, and discuss the challenges in the clinical application of intestinal and esophageal microbiota.

Acid-responsive contractile hyaluronic acid-based hydrogel loaded with ginsenoside Rg1 for hemostasis and promotion of gastric wound healing

Due to constant stimulation by stomach acid and local bleeding, gastric tissue wounds tend to heal slowly and complications such as anastomotic leakage have a high incidence. Suturing is often used to treat gastric wounds in clinic, but it still faces risks such as bleeding, slow healing, and leakage. Recently, hydrogel have been widely used to treat various types of wounds. Although hydrogels have shown promising efficacy in wound healing, it is still a challenge in dealing with wounds in gastric tissue for the poor adaptability of traditional materials in acidic environments. Hence, a series of pH responsive and good tissue adhesive hydrogels (MA-HA/AA) based on methacryloyl hyaluronic acid (MA-HA) and acryloyl-6-aminocaproic acid (AA) via in situ photo-crosslinking were designed, and anti-inflammatory and pro-healing traditional Chinese medicines ginsenoside Rg1 was incorporated into the hydrogel to treat gastric tissue wound. These acid-responsive hydrogels could form effective acid-resistant barriers and could lead to hemostasis rapidly through its strong adhesion. Besides, the hydrogels contracted under an acidic environment, which could tighten the gastric tissue wounds and sustained release the loaded ginsenoside Rg1. In addition, the hydrogels showed excellent biocompatibility and in vivo degradability. In summary, the acid-responsive contractile hyaluronic acid hydrogel loaded with ginsenoside Rg1 had good properties for hemostasis and acid-resistance to facilitate the promotion of gastric wounds healing.

Near-infrared light-responsive copper-cerium bimetallic oxide nanozyme with antibacterial and antioxidant abilities for periodontitis therapy

Periodontitis, a chronic inflammatory disease of the supporting tissue around teeth, is triggered by periodontal pathogens. Clinical treatments face the problem of bacterial resistance and most therapies focus on a single function, lacking the multifunctional treatment of antibacterial, antioxidant, anti-inflammatory, and osteogenic properties. In our study, we developed a copper-cerium bimetallic oxide (CuCeOx) nanozyme with near-infrared (NIR) light responsiveness for the periodontitis therapy. Under the excitation of 808 nm NIR light, CuCeOx displayed excellent photodynamic and photothermal activities, efficiently generating reactive oxygen species (ROS) and heat. After the treatment of the CuCeOx/NIR system, the inhibition rate of Porphyromonas gingivalis (P. gingivalis), the main periodontitis pathogen, reached 98.69 ± 0.23 % in vitro. Without the NIR light irradiation, CuCeOx, acting as a nanozyme, exhibited enzyme-like activity in scavenging ROS, effectively alleviating the cellular oxidative stress. Furthermore, CuCeOx significantly mitigated the cellular inflammatory response induced by lipopolysaccharide (LPS) and promoted osteogenesis under the oxidative stress condition. Notably, the CuCeOx exhibited excellent blood compatibility (hemolysis < 5 %). The efficacy of the CuCeOx/NIR system in vivo was also investigated. H&E staining results demonstrated a significant reduction in periodontal tissue inflammation following treatment. Micro-CT analysis revealed that CuCeOx effectively inhibited the alveolar bone loss. Additionally, we found CuCeOx regulated the Nrf2/HO-1 signaling pathway both in vitro and in vivo. In conclusion, the multifunctional nanomaterial CuCeOx provides a promising strategy for the treatment of periodontitis.

Sequential delivery of anti-inflammatory and anti-scar drugs by Rg3 liposome-embedded thiolated chitosan hydrogel eye drops for corneal alkali burn

Corneal injury is a major cause of inflammation, scarring, and even vision loss. The main treatment for corneal injury is local administration of eye drops. However, due to the limitation of the protective barrier of the eyes, conventional eye drops have the disadvantages of low bioavailability, high side effects, and limited efficacy. In this study, the anti-inflammatory agent dipotassium glycyrrhizate (DG) and the antifibrotic agent ginsenoside Rg3 were incorporated into a thermosensitive hydrogel in order to develop a multifunctional hybrid hydrogel eye drops (RDTG) for the synergistic treatment of corneal alkali burn. The hydrogel network was formed by thiolated chitosan and β-glycerophosphate through both physical and chemical crosslinking. DG was distributed in free state in the hydrogel, while Rg3 was incorporated into the hydrogel in the form of liposomes. Furthermore, RDTG showed the characteristic of sequential drug-release. In vivo studies using a mouse model of corneal alkali burn have confirmed that RDTG could effectively reduce inflammation, promote corneal wound healing, and inhibit corneal scar. Therefore, the efficient delivery of RDTG eye drops provided a promising approach for the treatment of corneal alkali burn.

Zn-DHM nanozymes regulate metabolic and immune homeostasis for early diabetic wound therapy

Diabetic wounds heal slowly or incompletely because of the microenvironment of hyperglycemia, high levels of reactive oxygen species (ROS), excessive inflammation, metabolic disorders and immune dysregulation, and the therapeutic effect is limited only by disruption of the reactive oxygen species (ROS)-inflammation cascade cycle. Here, a novel metal-polyphenolic nanozyme (Zn-DHM NPs) synthesized by the coordination of Zn2+ with dihydromyricetin (DHM) was designed, which not only has a superior ability to scavenge ROS and promote cell proliferation and migration but also functions in the regulation of metabolism and immune homeostasis. In vitro and in vivo experiments and RNA sequencing analyses revealed that Zn-DHM NPs could increase the levels of intracellular SOD and CAT enzymes to scavenge ROS and maintain the level of the mitochondrial membrane potential to reduce apoptosis. In terms of glucose metabolism, Zn-DHM NPs downregulated excessive levels of intracellular glucose and HK2, inhibited excessive glycolysis and downregulated the AGE-RAGE pathway to restore cellular function. In terms of immune regulation, Zn-DHM NPs not only downregulate M1/M2 levels to promote tissue repair but also maintain Th17/Treg homeostasis, downregulate the IL-17 signaling pathway to reduce inflammation, and upregulate FOXP3 to maintain immune homeostasis, thereby promoting early wound healing in diabetic mice. The development of Zn-DHM NPs provides a new therapeutic target to promote early healing of diabetic wounds.

Precision oncolytic viral therapy in colorectal cancer: Genetic targeting and immune modulation for personalized treatment (Review)

Colorectal cancer (CRC) is a leading health issue and treatments to eradicate it, such as conventional chemotherapy, are non‑selective and come with a number of complications. The present review focuses on the relatively new area of precision oncolytic viral therapy (OVT), with genetic targeting and immune modifications that offer a new future for CRC treatment. In the present review, an overview of the selection factors that are considered optimal for an oncolytic virus, mechanisms of oncolysis and immunomodulation applied to the OVT, as well as new strategies to improve the efficacy of this method are described. Additionally, cause‑and‑effect relationships are examined for OVT efficacy, mediated by the tumor microenvironment, and directions for genetic manipulation of viral specificity are explored. The possibility of synergy between OVT and immune checkpoint inhibitors and other treatment approaches are demonstrated. Incorporating the details of the present review, biomarker‑guided combination therapies in precision OVT for individualized CRC care, significant issues and future trends in this required area of medicine are highlighted. Increasingly, OVT is leaving the experimental stage and may become routine practice; it provides a new perspective on overcoming CRC and highlights the importance of further research and clinical work.

Current status of endoscopic treatment for esophageal diverticulum based on diverticular peroral endoscopic myotomy

Esophageal diverticulum can be broadly classified into three main types: Pharyngoesophageal diverticulum located near the upper esophageal sphincter (including Zenker’s diverticulum, Killian-Jamieson diverticulum, and Laimer’s diverticulum); Mid-esophageal diverticulum, and epiphrenic diverticulum located just above the lower esophageal sphincter. Most asymptomatic esophageal diverticulum are incidentally detected during routine imaging studies, such as barium swallow, computed tomography scans, or esophagogastroduodenoscopy. For these patients, regular follow-up is typically sufficient. However, a small subset may experience persistent symptoms such as dysphagia and acid reflux. Patients with symptomatic diverticulum should be assessed for the potential need for surgical intervention to prevent serious complications, including aspiration pneumonia and malnutrition. The treatment options for symptomatic esophageal diverticulum encompass both endoscopic and surgical approaches. Due to the technical complexity and significant risks associated with surgical intervention, endoscopic treatment has gained increasing preference, achieving remarkable results with the advancements in endoscopic instruments and techniques. Given the anatomical location and pathophysiological differences among esophageal diverticulum, a personalized endoscopic strategy is essential to achieve optimal results. This review provides an overview of the characteristics of esophageal diverticulum and offers a comprehensive discussion of diverticular peroral endoscopic myotomy and its related variations as the primary endoscopic treatment strategy.

Smart response CO hydrogel "battling" bacterial biofilms and inflammation associated with wounds

Bacterial infections accompanied by excessive inflammatory responses and bleeding can significantly impede wound healing, with biofilms further complicating treatment and reducing its effectiveness. Herein, an intelligent carbon monoxide (CO) gas-releasing and hemostatic hydrogel was developed, composed of carboxymethyl chitosan (CMCS), hyaluronic acid (HA), copper-doped mesoporous Prussian blue nanoparticles (named as Cu-HMPB NPs), luteolin, and Mn2(CO)10, through chemical and physical cross-linking. Cu-HMPB is loaded with luteolin, a natural flavonoid, and covalently bonded with the temperature-sensitive CO donor Mn2(CO)10. By utilizing cross-linking agents, CMCS and HA are physically loaded with Cu-HMPB@Lu@Mn nanoparticles (named as Cu-HLM NPs) to form the composite hydrogel (named as CuHLM/C-H). Under near-infrared (NIR) irradiation, the CuHLM/C-H hydrogel exhibited excellent photothermal capabilities and enabled on-demand CO gas release. The CO gas effectively penetrated mature biofilms and promoted their dissipation, synergizing with the photothermal effect to efficiently eradicate biofilms. The antioxidant properties of luteolin effectively prevents redox imbalance. Additionally, the CuHLM/C-H hydrogel demonstrated significant hemostatic effects in mouse liver and tail hemorrhage models. Collectively, the combination of gas therapy and photothermal therapy shows exceptional potential for addressing clinical issues caused by biofilms and associated inflammation.

Extracellular matrix-inspired natural polymer-based composite hydrogel dressings for infected wound healing

Developing an effective hydrogel dressing to protect against bacterial infection and exhibit synchronously integrated mechanical robustness and self-healing properties is highly desirable for infected wound healing in clinical practice. Inspired by the extracellular matrix (ECM), we constructed a dynamic and nondynamic synergy network to prepare a natural polymer-based composite hydrogel dressing for infected wound healing. The aldehyde groups of oxidized hyaluronic acid were bonded with amino groups of carboxymethyl chitosan and polyacrylamide (PAAm) via the Schiff base reaction to form a dynamic crosslinked network, mimicking the dynamically reversible glycosaminoglycan network in the ECM. A nondynamic PAAm network was created via UV-irradiated free radical polymerization, analogous to the covalently crosslinked collagen network in the ECM. The elaborate dynamic and nondynamic synergy network enabled the resultant hydrogel dressing to exhibit high mechanical strength and fatigue resistance, excellent self-healing properties and the remarkable antibacterial activity. An in vivo Staphylococcus aureus-infected full-thickness wound model revealed that our natural polymer-based composite hydrogel dressing significantly reduced inflammation and promoted the formation of granulation tissues and angiogenesis to achieve accelerated infected wound healing. This study offers a valuable reference for designing and fabricating multifunctional hydrogel dressings for treating wound infection.

Epidemiological characteristics of Helicobacter pylori infection and antibiotic resistance in urban areas of Guangdong Province, China: a multi-center, cross-sectional surveillance

PURPOSE

Helicobacter pylori (H. pylori) infection is widespread globally and can cause serious gastrointestinal complications, including gastric cancer. This study assesses the prevalence and antibiotic resistance of H. pylori in Guangdong, one of China's most developed provinces.

METHODS

A multi-center, cross-sectional study was conducted across six cities in Guangdong provinces, that is, Guangzhou, Shenzhen, Heyuan, Foshan, Yunfu, and Zhaoqing. Non-invasive gastric fluid samples were collected via the string test, and H. pylori infection and antibiotic resistance were detected using quantitative PCR. Risk factors for infection were analyzed.

RESULTS

Of 1,764 participants, 444 (25.17%) tested positive for H. pylori, with the highest infection rate in Foshan (29.81%). Antibiotic resistance testing of these 444 infected individuals revealed that, except for levofloxacin resistance in Yunfu (14.29%), clarithromycin resistance in Yunfu and resistance to other antibiotics in all cities exceeded the 15% threshold. Infection rates were significantly higher in males (OR 1.29, 95% CI 1.03-1.60, p = 0.03) and obese individuals (OR 2.04, 95% CI 1.04-3.91, p = 0.03), with obesity identified as an independent risk factor.

CONCLUSION

This study provides a comprehensive update on the prevalence, antibiotic resistance, and risk factors of H. pylori infection in Guangdong, offering valuable insights for public health strategies aimed at improving diagnosis and treatment.

Optimizing genetic testing strategy for suspected attenuated adenomatous polyposis: effective solutions in public health systems

BACKGROUND

APC and MUTYH genes are key in hereditary attenuated adenomatous polyposis syndromes. Guidelines recommend genetic testing based on polyp count, often overlooking age despite its impact on polyp prevalence.

AIM

To enhance genetic testing strategies for suspected attenuated adenomatous polyposis by combining polyp count and age in a probability calculator.

METHODS

Retrospective study of adult patients referred to NGS genetic testing for suspected attenuated adenomatous polyposis (accumulated history of < 100 adenomas) (discovery cohort, N = 138). Data included age, adenoma count, and test results. A multivariable logistic regression model was developed to associate positive genetic test results with age and adenoma count. The model was externally validated with 259 patients from two tertiary hospitals in our region (validation cohort, N = 259).

RESULTS

In the discovery cohort, 13 (9.4%) patients had pathogenic mutations, being younger (OR:0.91, 95%CI 0.86-0.96) and having more adenomas (OR:1.08, 95%CI 1.04-1.13) compared to negative cases. The logistic regression model combining age and polyp count demonstrated an AUC of 0.92. Using a cutoff probability of 3.5%, the model achieved 100% sensitivity and 58% specificity in identifying positive cases. In the external validation, the model accurately predicted 14 out of 16 positive cases (88%). The remaining two positive cases were a patient with an AXIN2 mutation in heterozygosis, and a patient with a NTHL1 mutation in homozygosis. Performance evaluation of both hospitals yielded AUC values of 0.77 and 0.90.

CONCLUSIONS

Older individuals with fewer polyps are less likely have hereditary syndromes. Including age in genetic testing criteria can enhance patient selection and cost-effectiveness.

Future prospects of deep learning in esophageal cancer diagnosis and clinical decision support (Review)

Esophageal cancer (EC) is one of the leading causes of cancer-related mortality worldwide, still faces significant challenges in early diagnosis and prognosis. Early EC lesions often present subtle symptoms and current diagnostic methods are limited in accuracy due to tumor heterogeneity, lesion morphology and variable image quality. These limitations are particularly prominent in the early detection of precancerous lesions such as Barrett's esophagus. Traditional diagnostic approaches, such as endoscopic examination, pathological analysis and computed tomography, require improvements in diagnostic precision and staging accuracy. Deep learning (DL), a key branch of artificial intelligence, shows great promise in improving the detection of early EC lesions, distinguishing benign from malignant lesions and aiding cancer staging and prognosis. However, challenges remain, including image quality variability, insufficient data annotation and limited generalization. The present review summarized recent advances in the application of DL to medical images obtained through various imaging techniques for the diagnosis of EC at different stages. It assesses the role of DL in tumor pathology, prognosis prediction and clinical decision support, highlighting its advantages in EC diagnosis and prognosis evaluation. Finally, it provided an objective analysis of the challenges currently facing the field and prospects for future applications.

Transoral septotomy versus Z-POEM in the treatment of Zenker diverticulum: a multicenter case-matched comparative study

INTRODUCTION

Transoral septotomy has become the favored treatment of Zenker Diverticulum (ZD), with POEM becoming a mini-invasive option also in ZD. The gold-standard treatment of ZD is still debated. We designed a case-matched comparative study to evaluate whether POEM (Z-POEM) could be as effective as stapler, traction-assisted Transoral Septotomy (TS) as first-line treatment of ZD.

MATERIALS AND METHODS

Consecutive naïve patients between 2015 and 2022 were enrolled in two high-volume centers. Barium-swallow and endoscopy were performed before and after surgery. Symptoms were assessed using a dedicated questionnaire. A control group was generated by matching patients who underwent Z-POEM with those who underwent TS. For matching the patients, a one-to-one nearest neighbor approach was used. Patients were matched for: septum length, symptoms duration, age, and sex.

RESULTS

After matching, 26 patients in each group were enrolled. The procedures were completed successfully in all patients in both groups, and mortality was null. TS required a shorter operative time. One leakage was detected in the Z-POEM group while one mucosal tear was detected in the TS group, both treated conservatively. At a median follow-up of 45 months (IQR: 27-68) for TS and 66 months (IQR: 58-76) for Z-POEM, a successful outcome was achieved in 96.2% in both groups. Post-operative symptom scores decreased in all patients in both groups.

CONCLUSIONS

This is the first study comparing Z-POEM and TS. Both the minimally invasive treatments are effective for naïve Zenker Diverticulum. TS provides a lower rate of intraoperative complications and a shorter operative time.

Portrayal of the complex molecular landscape of multidrug resistance in gastric cancer: Unveiling the potential targets

Gastric cancer (GC) is an aggressive malignancy among all Gastrointestinal cancer (GIC) types. Worldwide, among all cancer types, gastric cancer incidence and related mortality remain in fifth position. Multidrug resistance (MDR) in GC presents a major challenge to chemotherapy, and it significantly affects patient survival. A better understanding of the dynamic interaction of cellular factors contributing to MDR phenotype, e.g., the presence and expression of variants of MDR-related genes, including various drug-detoxifying and drug-efflux transporters, and expression of regulatory ncRNAs affecting the expression of MDR-related genes, is required to comprehend the molecular mechanisms for MDR development in GCs. This review article provides a holistic discussion of the cellular factors involved in the MDR development in GC cells, i.e., their roles and cross-talk between specific molecules that give rise to drug-sensitive and drug-resistant phenotypes. Moreover, the pharmacological perspective of drug resistance and the underlying biological processes that allow the escape of GC cells from the cytotoxic effects of drugs have also been discussed. Additionally, this review article provides an in-depth discussion on most potential candidates that can serve as MDR biomarkers in GIC cancer and the growing research interest in non-coding RNAs (ncRNAs) in GC. Notably, the miRNAs, circRNAs, and lncRNAs are not only emerging as crucial prognostic biomarkers of MDR in gastric cancers but also as potential targets for personalized medicine to combat the MDR challenge in GC patients.

Comparison of the efficacy and safety of basket catheters and balloon catheters for endoscopic pancreatic duct stone clearance

BACKGROUND

The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography (ERCP) for the clearance of pancreatic duct stones in patients with chronic pancreatitis (CP) remains controversial. This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.

METHODS

We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions. We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital, Naval Medical University between February 2012 and December 2021. After propensity score matching (1:1), 101 patients were included in each group. The primary outcome was the rate of pancreatic stone clearance. Secondary outcomes included the rate of adverse events during hospitalization, long-term pain relief, and quality of life after one year follow-up period.

RESULTS

The rate of complete clearance was comparable between the two groups (86.1% vs. 84.2%, P = 0.692). In patients with stones ≥ 2 cm before extracorporeal shock wave lithotripsy (ESWL), the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group [100% (19/19) vs. 70.0% (14/20), P = 0.031]. In the multivariate logistic analysis, ESWL prior to stone extraction was the only independent predictor of complete clearance [with ESWL 58.4% (264/452) vs. without ESWL 41.6% (188/452), odds ratio = 2.3, 95% confidence interval: 1.2-4.3; P = 0.013]. No significant differences between groups were found regarding the rates of adverse events during hospitalization, quality of life, and pain relief after one year of follow-up.

CONCLUSIONS

Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions. However, the balloon catheter was superior to the basket catheter if the pancreatic stone size was ≥ 2 cm before ESWL.

Comparison of pre-treatment with different diluted sufentanil in reducing propofol injection pain in gastrointestinal endoscopy: A randomized controlled study

BACKGROUND

This study aimed to investigate the efficacy of pre-treatment with different concentrations of sufentanil in mitigating propofol injection-induced pain.

METHODS

This study included 421 patients who were scheduled for gastrointestinal endoscopy between June 2023 and December 2024. Participants were randomly assigned to one of the four groups with different concentrations sufentanil: 0 µg/mL group(0.9% normal saline), 0.5 µg/mL group, 1 µg/mL group and 5 µg/mL group.

RESULTS

Among the four groups, the rates of pain relief were 82 (77.4%), 93 (89.4%), 96 (89.7%), and 91 (87.5%), respectively. Compared to the 0 µg/mL group, the other groups demonstrated significantly reduced pain following propofol injection (p < 0.05). The recovery times were 14.59 ± 3.92 min, 15.13 ± 3.20 min, 14.27 ± 3.06 min, and 15.57 ± 3.24 min, respectively. Notably, the 1 µg/mL group did not exhibit a prolonged recovery time compared to the 0 µg/mL group. The total propofol consumption was recorded as 218.5 ± 36.8 mg, 196.7 ± 31.0 mg, 183.8 ± 25.0 mg, and 189.6 ± 31.4 mg, respectively, with the 1 µg/mL group showing the lowest total propofol consumption among the groups. The incidences of adverse events (AEs) were 61.3%, 70.2%, 58.9%, and 76.9%, respectively. In comparison to the 1 µg/mL group, the 5 µg/mL group exhibited a higher incidence of AEs. Furthermore, multivariate analysis indicated that a 5 µg/mL dilution of sufentanil increases the risk of AEs (p < 0.05).

CONCLUSIONS

The 1 µg/mL group demonstrated greater safety and efficacy when combined with propofol.

TRIAL REGISTRATION

The study has been registered in the Chinese Clinical Trial Registry (ChiCTR). Link of the registry: http://www.chictr.org.cn. Date of registration: 2023/06/12. Trial registration number: ChiCTR2300072402.

CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients

Background

This study explores the factors related to the expression levels of carbohydrate antigen 199 (CA199) and carcinoembryonic antigen (CEA) and their association with poor postoperative prognosis in patients with esophageal squamous cell carcinoma (ESCC) who underwent minimally invasive resection.

Methods

Eighty patients with ESCC who underwent minimally invasive surgery were divided into two groups: 40 with poor prognosis (recurrence) and 40 with good prognosis (no recurrence). Additionally, 80 healthy subjects were selected as a control group. Serum CA199 and CEA levels were measured before surgery and 3 and 6 months postoperatively.

Results

The serum CA199 and CEA levels in the experimental group were significantly higher than in the control group (P < 0.05). Patients with poor prognoses within the experimental group had higher CA199 and CEA levels than those with good prognoses (P < 0.05). In the poor prognosis group, CA199 and CEA levels at 6 months were significantly higher than at 3 months post-surgery (P < 0.05).

Conclusion

Poor prognosis in ESCC patients after minimally invasive resection may be influenced by factors such as lymph node metastasis, lesion length, and tumor location. Elevated CA199 and CEA levels postoperatively can serve as predictors of poor prognosis in patients with ESCC.

Alterations of metabolites related to microbiota-gut-brain axis in plasma of colon cancer, esophageal cancer, stomach cancer, and lung cancer patients

Co-occurring symptoms such as depression, anxiety, fatigue, and sleep disorders are frequently comorbid with cancer. The causes of these cancer-related symptom clusters are hypothesized sharing a common biological mechanism. This study explored pattern differences of some gut metabolites (glucocorticoids, short-chain fatty acids, gut microbial metabolites from tryptophan) in plasma samples from patients with four types of cancer. Metabolomics analysis was performed to indicate the differences of metabolites. Discrimination model and diagnostic model were constructed using orthogonal partial least squares discriminant analysis, and differential metabolites were screened, then receiver-operating characteristic curve analysis was performed to evaluate the performance of these models. Melatonin (MLT), indole propionic, and skatole were screened as the common differential metabolites shared by four types of cancer, indicating that the intestinal microbial metabolic pathway of tryptophan plays a key role in the occurrence and development of malignant tumors. The area under the curve values for the potential candidate biomarker predictors in univariate analysis ranged from 0.771 to 0.989, and in multivariate analysis ranged from 0.985 to 1.00. The sensitivity and specificity of the multivariable model were 94.7-100 and 96.4-100%, respectively. These biomarkers also had good performance in discriminating different pairs of cancer. The analysis of gut microbiota metabolites allows us to characterize the common metabolic characteristics of patients with various cancers. The intestinal microbial metabolic pathway of tryptophan plays a key role in the occurrence and development of malignant tumors.

Transcriptomic profiling and bioinformatics-driven statistical prioritization of CRC biomarkers: A step toward precision oncology

Colorectal adenocarcinoma (COAD) is among the most common causes of cancer-related death globally. Early detection and targeted therapy depend on identifying key molecular biomarkers that drive tumor progression. The molecular heterogeneity of COAD demands robust computational strategies to improve the accuracy of biomarker discovery.

METHODS

We developed and implemented a comprehensive, multi-step bioinformatics and statistical pipeline to systematically prioritize clinically relevant biomarkers in COAD. This pipeline integrated differential gene expression analysis, protein-protein interaction (PPI) network construction, and functional enrichment analysis to identify key hub genes associated with tumor progression. We subsequently applied principal component analysis (PCA) and overall survival modeling to evaluate the diagnostic and prognostic relevance of these candidates. Receiver operating characteristic (ROC) curve analysis was used to assess their sensitivity and specificity. Finally, experimental validation of the prioritized hub genes was conducted via qPCR across three CRC cell lines (LoVo, HCT-116, and HT-29), confirming their upregulation and supporting their clinical potential.

RESULTS

Our integrative pipeline prioritized five key hub genes (CDH3, CXCL1, MMP1, MMP3, and TGFBI) as significantly upregulated in COAD tissues compared to normal controls. Functional enrichment analysis linked these genes to extracellular matrix degradation, epithelial-mesenchymal transition (EMT), inflammatory signaling, and tumor invasion, underscoring their roles in key oncogenic processes. Survival analysis revealed varying degrees of association with patient prognosis, most notably for CXCL1. Diagnostic performance, assessed by ROC analysis, yielded moderate AUC values (0.669-0.692), supporting their potential as biomarkers. Finally, qPCR validation across three CRC cell lines confirmed robust upregulation of all five genes, reinforcing their biological relevance in COAD progression.

CONCLUSION

Our study establishes a reproducible, integrative bioinformatics and statistical framework for the systematic identification of clinically actionable biomarkers in CRC. The five hub genes prioritized (CDH3, CXCL1, MMP1, MMP3, and TGFBI) demonstrated consistent diagnostic and prognostic value, offering a solid basis for the development of non-invasive molecular diagnostics and contributing to precision oncology.

Bacteria and Carcinogenesis and the Management of Cancer: A Narrative Review

There is a widely known relationship between certain microbes and cancer progression. For instance, Helicobacter pylori is associated with the occurrence of gastric cancer, while HPV is associated with cervical and head and neck cancers. Recent studies have uncovered novel and important associations between bacterial presence and tumor formation and treatment response. Apart from the influence of the intestinal microbiome on cancer, the local activity of bacteria affects disease properties as well. Bacteria can localize within tumors in less vascularized niches. Their presence mediates the activity of signaling pathways, which contribute to tumorigenesis. Furthermore, they affect the composition of the tumor microenvironment, a highly complex structure composed of immunoregulatory cells and secreted inflammatory mediators. Recently, researchers have analyzed the properties of bacteria to develop novel anticancer strategies. The aim of this review is to discuss the latest findings regarding the relationships between bacteria and cancer and the properties of bacteria that could be used to kill cancer cells.

Gut microbiome and colorectal cancer: From pathogenesis to treatment

Colorectal cancer (CRC) continues to rank among the most prevalent cancers worldwide. A growing body of research indicates that the microbiome significantly influences the onset, development, and progression of CRC, in addition to affecting the efficacy of various systemic therapies. The composition of the microbiome, shaped by factors such as bacterial strains, geography, ethnicity, gender, and dietary habits, provides essential information for CRC screening, early diagnosis, and the prediction of treatment responses. Modulating the microbiome presents a highly promising medical strategy for improving individual health. This review aims to present a thorough overview of recent research concerning the interplay between host microbiota and CRC, along with its implications for screening and the immune response against tumors in the context of cancer treatment.

Hydrogels in Endoscopic Submucosal Dissection for Gastrointestinal Cancers

Endoscopic Submucosal Dissection (ESD) has emerged as a pivotal technique for the minimally invasive treatment of early gastrointestinal cancers, offering benefits such as reduced trauma, lower complication rates, and cost-effectiveness. Despite its advantages, the selection of optimal biomaterials for submucosal injection poses significant challenges. Current materials used in clinical settings often suffer from rapid diffusion, requiring multiple injections and potentially causing localized inflammation. These issues underscore the importance of identifying more effective submucosal injection materials to minimize postoperative complications and enhance patient outcomes. Recent advancements have highlighted the potential of hydrogels in this context, favored for their ability to maintain mucosal elevation longer and support wound healing. This review comprehensively examines the development and application of hydrogels in ESD, focusing on their physicochemical properties, biocompatibility, and the clinical implications of their use. These issues discuss various formulations of hydrogels, their mechanisms of action, and comparative analyses with traditional materials. Furthermore, the review explores ongoing innovations and future perspectives in hydrogel research, aiming to catalyze further advancements in ESD techniques. STATEMENT OF SIGNIFICANCE: This review critically examines hydrogel technologies in endoscopic submucosal dissection for gastrointestinal cancers, highlighting their role in improving procedural outcomes and patient recovery. It explores hydrogels' ability to enhance mucosal elevation, reduce complications, and accelerate healing, offering insights into their transformative potential in medical treatments. The findings emphasize the development of innovative materials that could significantly advance clinical practices in gastrointestinal cancer management.

A methacrylated pullulan hydrogel incorporating phycocyanin-functionalized copper sulfide nanoparticles for photothermal antibacterial therapy and improved wound healing

Bacteria-associated wound infections impose a significant burden on patients and healthcare systems. Consequently, there is an urgent need to develop a novel multifunctional antibiotic-free dressing that can effectively prevent wound infections and promote healing. In this study, a multifunctional hydrogel (PulMA/CuS@PC) was synthesized by encapsulating phycocyanin-Functionalized copper sulfide nanoparticles (CuS@PC) in photo-crosslinkable methacrylated pullulan (PluMA), exhibiting photothermal antibacterial properties and enhanced wound healing capabilities. The PulMA/CuS@PC hydrogel exhibits excellent mechanical properties, favorable swelling ability, good biocompatibility, and effective photothermal antibacterial activity. The incorporation of CuS@PC NPs significantly enhances the hydrogel's photothermal antibacterial efficacy against Escherichia coli and Staphylococcus aureus. Furthermore, the PulMA/CuS@PC hydrogel demonstrated substantial wound healing capability in a mouse model of full-thickness skin infection. This was evidenced by a marked reduction in inflammatory response as well as notable improvements in both wound healing and collagen deposition. This study underscores the potential clinical application of the developed multifunctional PulMA/CuS@PC hydrogel as an innovative wound dressing designed to prevent infection while facilitating skin regeneration.

A NIR-Responsive Deep Penetration Phototherapy Strategy for Treating Infected Skin Defect via Antibacterial Effect and Inflammation Elimination

The increasing severity of antibiotic resistance and the delayed healing of infected wounds have triggered an arduous challenge that threatens human health. Instantly, quiet a few novel, efficient, and safe antibacterial strategies are urgently needed to be explored. In this study, a NIR-activated antibacterial nanocomposite (RB/UCNPs@BP) integrating rose bengal-sensitized upconversion nanoparticles (RB/UCNPs) and black phosphorus (BP) is developed for promoting infection wound healing. The photodynamic therapy (PDT) and photothermal therapy (PTT) are employed here for synergistic antibacterial action, while UCNPs further improve the penetration depth of irradiation and treatment efficiency. More importantly, the typical biodegradability of BP confers reduced resistance on nanocomposites through residual-free antimicrobial methods. The results show that RB/UCNPs@BP significantly inhibits the growth of both Escherichia coli (E.coli) and Staphylococcus aureus (S.aureus) via enhanced PDT and PTT. Besides, the infected wounds achieve better healing by accelerating fibroblast proliferation and migration, reducing inflammatory cell infiltration, and promoting neuronal regeneration and angiogenesis. This study provides a promising and anti-resistant strategy with light-triggered antibacterial and anti-inflammatory activities that can promote the regeneration of infected skin tissue.

Hybrid Biological Hydrogel Provides Favorable Bioenergetic, Adhesive, and Antioxidative Effects on Wound Healing

Wound healing is a dynamic and complex process that demands substantial energy expenditure and a biomimetic microenvironment. Developing a simple and effective biological hydrogel to enhance mitochondrial energy metabolism could effectively promote wound healing. To this end, we developed a hybrid biological hydrogel based on Escherichia coli lipoate protein ligase A (LplA), which combines its catalytic and self-assembling properties to promote wound healing. In murine fibroblast L929 cell models, LplA significantly enhances cellular activity and intracellular metabolism, promoting cell proliferation and energy supply. However, cells aggregated into spherical clusters on the pure LplA hydrogel. To address this issue, we integrated glutaraldehyde (GA) as a cross-linker into the LplA hydrogel. The GA-LplA hydrogel enhances cell adhesion and proliferation and, unexpectedly, exhibits higher catalytic activity compared with the pure LplA hydrogel. Furthermore, LplA was observed to decompose H2O2, and the GA-LplA hybrid hydrogel significantly reduced reactive oxygen species (ROS) production. The promise of this hybrid hydrogel is successfully demonstrated in a male mice full-thickness skin defect model with accelerated re-epithelialization and cell proliferation while reducing inflammation.

Evaluating the detection rate and pathological features of polyps in patients with upper gastrointestinal endoscopy

BACKGROUND

The incidence of gastric polyps (GPs) has ranged from 0.30% to 6.8% in various studies. Most GPs include hyperplastic polyps (HPs), fundic gland polyps (FGPs), and adenomatous polyps (APs). Although APs have a high malignant potential, HPs have a low risk of potential harm, whereas sporadic FGPs have no malignant potential. It is not enough to determine the type and displacement of a polyp by biopsy alone; therefore, some polyps may require an extensive biopsy or complete resection.

AIM

To evaluate the detection rate and pathological features of polyps in patients undergoing upper gastrointestinal endoscopy.

METHODS

This retrospective study included patients with GPs or polyphenic lesions with polyps or malignant histology found in polyps or by gastroscopy at the Department of Gastroenterology at the Shaanxi Provincial Hospital of Traditional Chinese Medicine from 2019 to 2023.

RESULTS

In a series of 10000 patients who underwent upper gastrointestinal endoscopy, 384 (3.84%) had GPs. There were 98 males (25.5%) and 286 females (74.5%). The mean age of patients was 62.8 ± 10.4 (36-75) years. The frequencies of HPs, APs, and FGPs were 88.5%, 5.2%, and 2.1%, respectively. The polyp size of 274 patients (71.3%) was ≤ 1 cm. Polyps were found in 262 cases (68.2%). The most common sites for polyps were the lumen and body of the intestine. Endoscopic polypectomy was performed in 128 patients. Bleeding events were observed and endoscopic treatment was required after endoscopic polypectomy.

CONCLUSION

The incidence of GPs was low. HPs were the most common types of GPs. Of note, as GPs have the potential to develop into adenocarcinoma or precancerous lesions, we suggest that appropriate GP resection technology (e.g., biopsy forceps or mesenchymal resection) be applied.

Metalloproteinase-responsive gelatin/polylysine hydrogel microneedles for on-demand curcumin delivery in bacteria-infected wound healing

Effective management of bacterial infection and inflammatory responses is critical for accelerating infected wound healing. Herein, we develop a multifunctional hydrogel microneedle system (GMPL@GC MNs) integrating gelatin methacryloyl (GM) as the matrix material, ε-poly-L-lysine (PL) for enhanced antibacterial properties, and gelatin-curcumin nanoparticles (GC NPs) for inflammation modulation. The system exploits elevated matrix metalloproteinase (MMP) levels at wound sites to trigger specific degradation of GC NPs and controlled curcumin (Cur) release. This MMP-responsive mechanism enables reactive oxygen species (ROS) scavenging, inflammatory response suppression, and sustained drug delivery over 96 h. In bacteria-infected wound models, the GMPL@GC MNs demonstrate excellent therapeutic efficacy, achieving 99.1 % wound closure rate within 10 days through combined antibacterial, antioxidant, and anti-inflammatory actions. The system's multifunctionality and microenvironment responsiveness present strong potential for clinical wound management applications.

Research status and progress of deep learning in automatic esophageal cancer detection

Esophageal cancer (EC), a common malignant tumor of the digestive tract, requires early diagnosis and timely treatment to improve patient prognosis. Automated detection of EC using medical imaging has the potential to increase screening efficiency and diagnostic accuracy, thereby significantly improving long-term survival rates and the quality of life of patients. Recent advances in deep learning (DL), particularly convolutional neural networks, have demonstrated remarkable performance in medical imaging analysis. These techniques have shown significant progress in the automated identification of malignant tumors, quantitative analysis of lesions, and improvement in diagnostic accuracy and efficiency. This article comprehensively examines the research progress of DL in medical imaging for EC, covering various imaging modalities such as digital pathology, endoscopy, computed tomography, etc. It explores the clinical value and application prospects of DL in EC screening and diagnosis. Additionally, the article addresses several critical challenges that must be overcome for the clinical translation of DL techniques, including constructing high-quality datasets, promoting multimodal feature fusion, and optimizing artificial intelligence-clinical workflow integration. By providing a detailed overview of the current state of DL in EC imaging and highlighting the key challenges and future directions, this article aims to guide future research and facilitate the clinical implementation of DL technologies in EC management, ultimately contributing to better patient outcomes.

Safety and efficacy analysis of neoadjuvant radiotherapy combined with concurrent paclitaxel plus nedaplatin versus other platinum-based chemotherapy for thoracic segmental esophageal squamous cell carcinoma

Background

Esophageal cancer is among the leading causes of cancer-related mortality in males. This study aimed to evaluate the efficacy and safety of nedaplatin (NDP) in comparison to other platinum-based (OPB) agents combined with paclitaxel and concurrent neoadjuvant radiotherapy for locally advanced thoracic segmental esophageal squamous cell carcinoma (ESCC).

Methods

This single-center, retrospective cohort study was conducted in China. The primary endpoints of this study were safety and efficacy assessments. Unpaired t-tests, chi-squared tests, and Fisher's exact tests were used to compare intergroup differences, as appropriate. Multivariate logistic regression models were used to explore the associations between postoperative outcomes and the two treatment groups. Kaplan-Meier survival curves and Cox proportional hazards regression models based on OS and PFS were used to compare the efficacy between the two groups.

Results

A total of 212 patients were enrolled in this retrospective cohort study, including 79 who received NDP and 133 who received OPB (82 were treated with cisplatin, 20 with carboplatin, 19 with lobaplatin, and 12 with oxaliplatin) agents. The incidences of grade 3-4 acute radiotherapy-associated esophagitis, pneumonitis, and leukemia were significantly lower in the NDP group than in the OPB group (p = 0.02, p < 0.001, and p = 0.002, respectively). All grades of acute gastrointestinal reactions, including nausea, vomiting, anorexia, and diarrhea, were significantly more frequent in the OPB group than in the NPD group (p < 0.001, p = 0.032, p < 0.001, and p = 0.002, respectively). The Kaplan-Meier curves for overall survival (OS) and progression-free survival (PFS) showed similar results for both groups.

Conclusions

The safety profile of nedaplatin may be superior to those of other platinum-based agents in terms of acute radiotherapy toxicity and postoperative side effects; however, there was no difference in the efficacy between the two groups regarding short-term prognostic tumor regression grades or long-term OS and PFS.

Acid-Triggered Charge-Switchable Antibacterial Hydrogel for Accelerated Healing of Gastric Mucosal Wounds

Infection with Helicobacter pylori (H. pylori) is a primary etiological factor for chronic gastritis, peptic ulcers, and gastric cancer. The limited specificity of antibiotics against H. pylori, combined with the risk of severe adverse events from endoscopic submucosal dissection (ESD), presents a major global health challenge in treating gastric mucosal injuries. To address this issue, we developed a targeted antibacterial hydrogel based on a charge-reversal amphiphilic molecule, designed for the harsh gastric acid environment and capable of immediate and strong adhesion. The hydrogel is composed of acryl aspartate (AASP) and cysteine-grafted carboxymethyl chitosan (CMCS-NAC) as the base matrix, integrated with gastric acid-responsive charge-reversal antibacterial molecules (C16N-DCA). Simulated studies show that C16N-DCA undergoes charge reversal under acidic conditions (pH 3), enabling targeted H. pylori eradication mediated by gastric acid, with 98% efficacy and sustained antibacterial activity for up to 36 h. In vitro and in vivo experiments in rodent and porcine models confirmed its safety and efficacy in acidic gastric conditions. This hydrogel offers strong tissue protection and effectively modulates the gastric wound microenvironment, facilitating wound healing and presenting an easily adoptable solution for gastric wound management.

Targets and promising adjuvants for improving breast tumor response to radiotherapy

Breast cancer ranks among the most common cancers globally, with significant mortality rates in advanced stages. Despite progress in treatment, therapy resistance, particularly to radiotherapy, remains a major challenge. Radiosensitization offers a promising solution to enhance radiotherapy effectiveness. This approach specifically increases tumor cells' vulnerability to IR. Recent research has explored molecular targets and strategies to improve radiosensitivity in breast cancer. Examples include inhibiting DNA repair pathways, altering the TME, targeting signaling pathways, and using immunomodulators. These strategies not only amplify destructive effects of IR but may also reduce required radiation doses, thereby minimizing normal tissue injury. This review examines promising molecular targets and combination therapies to boost radiosensitivity in breast cancer. It also highlights recent advances in immune modulation, TME remodeling, targeted molecular therapy, and metabolic pathway targeting. These advancements offer insights into the future of radiosensitization research. By systematically analyzing these strategies, the article aims to provide a comprehensive understanding of radiosensitization's current state and future potential in breast cancer treatment.

Endoscopic resection of a cervical esophageal retention cyst presenting with recurrent pharyngeal discomfort

This is a Clinical Image, and an abstract is not typically required for this article type. If further information is needed, please contact the authors.

MTHFD2: A significant mitochondrial metabolic enzyme and a novel target for anticancer therapy

Methylenetetrahydrofolate dehydrogenase 2 (MTHFD2) is a crucial mitochondrial enzyme that operates within the folate one-carbon metabolic pathway. In recent years, it has been discovered that its expression is upregulated in numerous tumors and is correlated with the onset and progression of tumors, as well as poor prognosis. In contrast to its isoenzymes, it is overexpressed in tumors and is either expressed at low levels or not expressed at all in normal tissues. Consequently, it has received extensive attention and has been proposed as a novel anticancer target. In this paper, we review the functions of MTHFD2 in tumors, its regulatory mechanisms, and research progress on MTHFD2 inhibitors. Additionally, we provide insights into future research directions and the design and development of inhibitors for MTHFD2.

Controlled release of ionic carrier hydrogels for sequential immunomodulation to facilitate stage-specific treatment of infectious wound

Infected wounds present a significant clinical challenge, exacerbated by antibiotic resistance, which complicates effective treatment. This study introduces a hydrogel (CC/AP@CM) embedded with core-shell bioactive glass nanoparticles designed for the controlled, sequential release of copper (Cu2+) and magnesium (Mg2+) ions. The hydrogel is crosslinked via a Schiff base reaction, endowing it with injectable, self-healing, and adhesive properties. Notably, the bilayer structure of the bioactive glass within the hydrogel allows an initial release of Cu2+ ions to trigger an early-stage pro-inflammatory and antimicrobial response, followed by Mg2+ ions that support tissue repair and an anti-inflammatory environment. This design aligns with natural wound healing stages, promoting a shift in macrophage polarization from the M1 to M2 phenotype, effectively balancing antibacterial defense with tissue regeneration. The hydrogel demonstrated robust antibacterial efficacy against MRSA, increased angiogenesis, and enhanced fibroblast proliferation and migration in vitro. In a murine wound model, it significantly accelerated wound closure and immune activation, including responses from dendritic cells and T cells. These findings suggest that this hydrogel, through its stage-specific immunomodulatory properties and temporally controlled ion release, offers a promising strategy for treating complex wound infections, supporting both immune defense and tissue healing.

Study of Folate-Modified Carboxymethyl Chitosan-Sinomenine-Curcumin Nanopolymer for Targeted Treatment of Rheumatoid Arthritis

Sinomenine hydrochloride (SH) has been clinically utilized for many years to treat rheumatoid arthritis (RA) in both oral and injectable forms. However, its low bioavailability, poor targeting, high dosage requirements, and side effects, present significant challenges. This study developed folic acid-carboxymethyl chitosan-modified sinomenine-curcumin nanopolymers (named SCNP) for the targeted treatment of RA, to reduce dosage and side effects. The design of SCNP employs folic acid (FA) as a targeting moiety, facilitating specific binding to the folate receptor (FR) on the surface of macrophages and enabling internalization into activated macrophages via endocytosis, thereby achieving targeted delivery to sites of inflammation. In a rat and cell model of RA, SCNP was found to decrease reactive oxygen species (ROS) and pro-inflammatory factors while increasing the anti-inflammatory factor IL-10 through the NF-κB/NLRP3 pathway. These findings indicate that SCNP has the potential to lower drug dosage, enhance therapeutic efficacy, and minimize side effects such as diarrhea and rash, thereby highlighting its promise as an inflammation-targeting nanopolymer.

Identification of a Biomarker Panel in Extracellular Vesicles Derived From Non-Small Cell Lung Cancer (NSCLC) Through Proteomic Analysis and Machine Learning

Antigen fingerprint profiling of tumour-derived extracellular vesicles (TDEVs) in the body fluids is a promising strategy for identifying tumour biomarkers. In this study, proteomic and immunological assays reveal significantly higher CD155 levels in plasma extracellular vesicles (EVs) from patients with non-small cell lung cancer (NSCLC) than from healthy individuals. Utilizing CD155 as a bait protein on the EV membrane, CD155+ TDEVs are enriched from NSCLC patient plasma EVs. In the discovery cohort, 281 differentially expressed proteins are identified in TDEVs of the NSCLC group compared with the healthy control group. In the verification cohort, 49 candidate biomarkers are detected using targeted proteomic analysis. Of these, a biomarker panel of seven frequently and stably detected proteins-MVP, GYS1, SERPINA3, HECTD3, SERPING1, TPM4, and APOD-demonstrates good diagnostic performance, achieving an area under the curve (AUC) of 1.0 with 100% sensitivity and specificity in receiver operating characteristic (ROC) curve analysis, and 92.3% sensitivity and 88.9% specificity in confusion matrix analysis. Western blotting results confirm upregulation trends for MVP, GYS1, SERPINA3, HECTD3, SERPING1 and APOD, and TPM4 is downregulated in EVs of NSCLC patients compared with healthy individuals. These findings highlight the potential of this biomarker panel for the clinical diagnosis of NSCLC.

Cryo-EM reveals mechanisms of natural RNA multivalency

Homo-oligomerization of biological macromolecules leads to functional assemblies that are critical to understanding various cellular processes. However, RNA quaternary structures have rarely been reported. Comparative genomics analysis has identified RNA families containing hundreds of sequences that adopt conserved secondary structures and likely fold into complex three-dimensional structures. In this study, we used cryo-electron microscopy (cryo-EM) to determine structures from four RNA families, including ARRPOF and OLE forming dimers and ROOL and GOLLD forming hexameric, octameric, and dodecameric nanostructures, at 2.6- to 4.6-angstrom resolutions. These homo-oligomeric assemblies reveal a plethora of structural motifs that contribute to RNA multivalency, including kissing-loop, palindromic base-pairing, A-stacking, metal ion coordination, pseudoknot, and minor-groove interactions. These results provide the molecular basis of intermolecular interactions driving RNA multivalency with potential functional relevance.

Periostin acts as an oncogene to promote laryngeal cancer progression by activating decorin

Laryngeal carcinoma (LC) is the second most common malignancy of the head and neck worldwide, with increasing incidence every year. However, the mechanism of its development is not completely clear. Periostin (POSTN) has been reported to be involved in various aspects of tumorigenesis. To determine the influence of POSTN on LC tumorigenesis, we first examined the expression of POSTN in tissues from patients with LC through immunohistochemistry, western blot, and qRT-PCR. Besides, we demonstrated that POSTN promoted LC cell migration, invasion, and proliferation in vitro by CCK-8, colony formation, and Transwell assays, and tumor growth in vivo by immunohistochemistry. Furthermore, the interaction between POSTN and decorin (DCN) was further verified by bioinformatics analysis and immunoprecipitation (IP), finding that POSTN promoted the malignant progression of LC by targeting DCN. Our findings support the idea that the level of POSTN expression and accumulation in tumors correlated with the malignancy degree of LC, suggesting that POSTN may play a potential role in improving laryngeal cancer treatment strategies.

Preparation of pH-enzyme dual-responsive gel microspheres and their treatment of ulcerative colitis

Mesalazine (MSZ), a first-line treatment for ulcerative colitis (UC), was formulated into acid-resistant, colon-targeted gel microspheres to reduce upper gastrointestinal tract (GIT) exposure and extend drug retention in the colon. In this study, we used MSZ/hydroxypropyl-β-cyclodextrin (MSZ/HP-β-CD) as the model drug, dopamine-modified sodium alginate (DA-SA) and konjac glucomannan (KGM) as the carrier matrix, and chitosan (CS) as the coating material. The colon-targeted gel microspheres (MSZ/HP-β-CD/DA-SA/KGM/CS) were prepared using the drop method. These microspheres had a drug loading capacity of 7.9 ± 0.01 % and an encapsulation efficiency of 72.5 ± 0.03 %. The drug primarily released in the colon environment, showing pH and β-mannanase sensitivity. The dried microspheres measured approximately 0.6 mm, suitable for oral administration. In the rat UC model, after oral administration of gel microspheres, the colon length increased, while the DAI score, spleen index, and the expression levels of IL-6, IL-1β, TNF-α, TLR4, MyD88 and NF-κB p65 all decreased. Histopathological examination showed that treated UC rats' colon tissues closely resembled those of healthy controls. These findings indicate that pH-enzyme-responsive coated gel microspheres can effectively target the colon and show potential for UC treatment.

A Bio-Adaptive Janus-Adhesive Dressing with Dynamic Lubrication Overlayer for Prevention of Postoperative Infection and Adhesion

Wound postoperative infection and adhesion are prevalent clinical conditions resulting from surgical trauma. However, integrating intraoperative repair and postoperative management into a dressing suitable for wounds with unpredictable surface shapes and surroundings remains a formidable challenge. Here, we attempt to introduce a dynamic antifouling surface as wound protective covering and report an in situ formation of slippery-adhesive Janus gel (SAJG) by assembling hydrogel (N-hydrosuccinimide ester-activated powders) and elastomer (Silicon oil-infused polydimethylsiloxane). First powders can rapidly absorb interfacial water to gel and bond to tissue based on network entanglement, forming a tough adhesive hydrogel. Then precured organosilicon is applied to hydrogel and bonded together, forming a slippery elastomer. Due to the molecular polarity difference between hydrogel and elastomer, SAJG exhibits anisotropic surface behavior as evidenced by liquid repellency (hydrophilic vs. hydrophobic), and adhesion performance (bioadhesion vs. antiadhesion). Further, in vivo models are constructed and results demonstrated that the SAJG can effectively prevent bacterial infection to promote wound healing and avoid postoperative adhesion. Predictably, the morphologically adaptive SAJG with slippery and adhesive properties will have tremendous potential in addressing complex wound infections and postoperative complications.

Advanced Multiparametric MRI Strategies for Tumor Restaging After Neoadjuvant Therapy in Locally Advanced Gastric Cancer

BACKGROUND

This study tested the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in restaging locally advanced gastric cancer after neoadjuvant therapy (NAT) using pathologic T stage (ypT) and pathologic N stage (ypN) as the reference standard.

METHODS

Between August 2022 and September 2023, the study enrolled a prospective cohort of 70 gastric cancer patients who underwent NAT and subsequent surgical resection. MRI procedures, including DLSB T2-weighted imaging (T2WI), ZOOMit diffusion-weighted imaging (DWI), and XD-VIBE dynamic contrast-enhanced imaging (DCE), were performed after NAT and before surgery. Four abdominal radiologists independently assigned radiologic T stage (yrT) and radiologic N stage (yrN) based on individual and combined sequences. Inter-reader agreement was quantified using Kendall's coefficient. Diagnostic accuracy was determined by comparing MRI assessments and pathologic outcomes, with pairwise comparisons analyzed via the McNemar test. Subgroup analysis evaluated the performance in identifying good responders to NAT.

RESULTS

Inter-reader agreement was almost perfect for T restaging and substantial for N restaging. Diagnostic accuracy for T restaging was 0.432 using DLSB-T2WI, 0.586 using ZOOMit DWI, 0.557 using XD-VIBE DCE, and 0.586 using mpMRI. The accuracy demonstrated by DWI, DCE and mpMRI was superior to that of T2WI (all P < 0.05). For N restaging, the accuracy of the mpMRI protocol was 0.443. Notably, mpMRI achieved an AUC of 0.879 (95% confidence interval 0.835-0.915) for differentiating ypT0-1 tumors.

CONCLUSIONS

Advanced mpMRI strategies can serve as a valuable tool for restaging gastric cancer after NAT. Accurately differentiating good responders to neoadjuvant therapy through mpMRI holds significant clinical implications for personalized treatment strategies and improved patient outcomes.

Intratumoral microbiota: a new force in the development and treatment of esophageal cancer

Esophageal cancer (EC) ranks among the most prevalent cancers worldwide, with a particularly high incidence in the Asian population. Due to the inconspicuous nature of early symptoms, patients with esophageal cancer are typically diagnosed in the middle to late stages, resulting in suboptimal overall treatment outcomes. Consequently, there is an urgent need to explore and refine therapeutic strategies. Microorganisms have been identified in numerous tumor tissues, including EC, and these microorganisms are referred to as the intratumoral microbiome. Intratumoral microbiota and their metabolic byproducts can influence the progression and treatment of esophageal cancer through various mechanisms, such as modulating tumor cell metabolism and local immune responses. Therefore, the intratumoral microbiota may potentially serve as a target for the treatment of esophageal cancer. This review delineates the composition, origin, and diagnostic significance of intratumoral microbiota in esophageal cancer tissue, and discusses the mechanisms by which intratumoral microbiota contribute to the onset of esophageal cancer. In addition, the impact of intratumoral microbiota on the treatment of esophageal cancer and its intervention measures are also addressed.

Multifunctional Carbon Quantum Dots for Monitoring and Therapy of Bacterial Infected Wounds

Bacterial infections in wounds and bacteremia present significant global health challenges, driving the urgent need for innovative alternatives to traditional antibiotics. Here, the development of PEI-EDTA-2Na carbon quantum dots (PECDs) synthesized via a hydrothermal method is reported. Synthesis conditions affect PECDs' antibacterial efficacy; those at 180 °C have optimal -NH2 functionalization for better adhesion and activity. PECDs are pH - responsive, eradicating bacteria in weakly acidic conditions by disrupting DNA and proteins. Following the resolution of infection, PECDs adapt to neutral and alkaline environments, where they scavenge reactive oxygen species (ROS), reduce inflammation, promote macrophage polarization, and accelerate wound healing. Furthermore, PECDs significantly improve survival in bacteremia models. Their intrinsic fluorescence enables real-time pH monitoring of wounds, offering a non-invasive diagnostic tool. Genomic and transcriptomic analyses reveal that PECDs disrupt bacterial metabolism and resistance pathways, while simultaneously supporting antibacterial and anti-inflammatory responses during tissue repair. This dual functionality-combining therapeutic efficacy in wound healing with antimicrobial and anti-inflammatory properties in bacteremia-positions PECDs as a versatile platform for smart wound management and an emerging candidate for advanced biomedical applications.